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Tdap immunization DATE EACH DOSE WAS GIVEN VACCINE 1ST POLIO OPV or IPV 2ND 3RD 4TH 5TH / MMR Measles mumps and rubella HIB Required only for child care and preschool HEPATITIS B VARICELLA Chickenpox HEPATITIS A Not required DPT/DTaP/DT/Td Diphtheria tetanus and a cellular pertussis OR tetanus and diphtheria only Booster EXEMPTIONS FOR IMMUNIZATIONS I hereby request exemption of this child from the immunization requirements for school entry because these immunizations are contrary to my...
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The release of liability amp is a form used to notify the Department of Motor Vehicles (DMV) that you have sold or transferred your vehicle to another party.
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