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The period of provisional enrollment shall begin on the date the certificate is signed. To be valid the certificate shall be completed in its entirety including an expiration date and list of remaining vaccines required to qualify for a Certificate of Immunization Certificate Expiration Date Remaining vaccine s required Diphtheria Tetanus Pertussis DTaP/DTP/DT/ Td/Tdap Signature Date Given Doctor / Clinic / Source Polio IPV/OPV Measles Mumps Rubella MMR Haemophilus influenzae type b Hib...
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