Annual Physical and Immunization Records Request Annual Physical Form and Immunization Records Request This form, along with your child’s immunization record, must be returned to the school before your child can be admitted. Student's Name* First Last Student's Name First Last If you have more than one student at White Rock Montessori, you may enter their name(s) here.Student's Name First Last If you have more than one student at White Rock Montessori, you may enter their name(s) here.Doctor's Name* First Last Doctor's Email Address* Upon submitting this form, an email will be sent to the doctor's office requesting that they complete an online form.