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ASU Influenza Vaccine Release Form 2017-2025 free printable template

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TC SIG WELLNESS CENTER. 1174 Live Oak Blvd. Cuba City, CA 95991. (530) 822-5500 fax: (530) 822-5503. Influenza Vaccine Consent Form 2017-2018.
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How to fill out ASU Influenza Vaccine Release Form

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How to fill out ASU Influenza Vaccine Release Form

01
Obtain the ASU Influenza Vaccine Release Form from the ASU health services website or office.
02
Fill in your personal information in the designated fields, including your name, student ID, and contact details.
03
Indicate whether you have received the influenza vaccine, providing the date and place of vaccination if applicable.
04
If you are opting out of the vaccine, provide a reason for exemption as required by the form.
05
Sign and date the form to certify that the information provided is accurate.
06
Submit the completed form to the ASU health services office either in person or via the designated online submission method.

Who needs ASU Influenza Vaccine Release Form?

01
All ASU students who wish to register for classes or live on campus and have not received the influenza vaccine.
02
Students who are exempting themselves from the vaccine for medical or religious reasons.
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The ASU Influenza Vaccine Release Form is a document used by Arizona State University to obtain consent from individuals to receive the influenza vaccine and to record their vaccination status.
All students, faculty, and staff at Arizona State University who wish to receive the influenza vaccine are required to file the ASU Influenza Vaccine Release Form.
To fill out the ASU Influenza Vaccine Release Form, individuals must provide their personal information, including name, date of birth, and contact information, along with their consent to receive the vaccine.
The purpose of the ASU Influenza Vaccine Release Form is to document an individual's consent to receive the influenza vaccine and to ensure proper record-keeping of vaccination status.
The ASU Influenza Vaccine Release Form must include personal identification details, vaccination history, and acknowledgment of the risks and benefits of receiving the vaccine.
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