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Submit form if you have received the influenza vaccination either at a UPMC or outside facility i.e. CVS Giant Eagle Rite Aid Wal-Green s etc.. Completed forms should be uploaded to your CastleBranch profile no later than November 1st. Student Name Class of For the School Year include year of influenza vaccine i.e. 2016-17 RECEIVED SEASONAL INFLUENZA VACCINATION I attest that I received the Seasonal Influenza Vaccine on date mm/dd/yyyy I received the influenza vaccine at the following...
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