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AFFIDAVIT Refusal of Immunization of Student for Religious or Philosophical Reasons This Affidavit is being submitted on behalf of: (Name of Student) (Birthdate of Student mm/dd/YYY) If the student
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How to fill out refusal of immunization of
How to fill out refusal of immunization of
01
Obtain the refusal of immunization form from the appropriate authority.
02
Fill in your personal information including your name, address, and contact details.
03
Provide information about the person for whom the immunization refusal is being filed, such as their name, age, and relationship to you.
04
Clearly state the reasons for refusing immunization, ensuring to include any relevant medical or religious grounds.
05
Sign and date the refusal form.
06
Make copies of the completed form for your records.
07
Submit the refusal of immunization form to the appropriate authority, following any specific instructions provided.
Who needs refusal of immunization of?
01
Individuals who have legal or valid personal grounds to refuse immunization.
02
Parents or legal guardians who wish to exempt their children from mandatory immunization requirements.
03
Individuals who have medical conditions or allergies that prevent them from safely receiving immunizations.
04
Individuals who hold religious or philosophical beliefs that conflict with immunization practices.
05
Individuals who have previously experienced adverse reactions to vaccines.
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What is refusal of immunization of?
Refusal of immunization is the act of declining to receive vaccinations.
Who is required to file refusal of immunization of?
Parents or legal guardians of children who are not vaccinated are required to file a refusal of immunization.
How to fill out refusal of immunization of?
To fill out a refusal of immunization, the parent or legal guardian must provide their contact information and reason for refusing vaccination.
What is the purpose of refusal of immunization of?
The purpose of refusal of immunization is to document the decision to not vaccinate and ensure compliance with immunization laws.
What information must be reported on refusal of immunization of?
The refusal of immunization form typically requires information such as the child's name, date of birth, and the vaccines being declined.
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