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CCA1163A FOR FF (911) ARIZONA DEPARTMENT OF ECONOMIC SECURITYChild Care AdministrationAFFIDAVIT OF IMMUNIZATION EXEMPTION For Household Members Age 13 and YoungerGeneral Information CHILD\'S NAME
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How to fill out cca-1163a affidavit of immunization

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How to fill out cca-1163a affidavit of immunization

01
Obtain the cca-1163a affidavit of immunization form from a healthcare provider or the appropriate government agency.
02
Fill in your personal information, including your name, date of birth, and contact details, in the designated sections of the form.
03
Provide your immunization history by listing all the vaccines you have received. Include the dates of administration and the names of the vaccines.
04
If you have any medical exemptions or contraindications to certain vaccines, provide documentation supporting these exemptions.
05
Sign the affidavit of immunization form, certifying that the information provided is true and accurate to the best of your knowledge.
06
Submit the completed form to the appropriate authority, such as your school or the government agency responsible for immunization records.

Who needs cca-1163a affidavit of immunization?

01
The cca-1163a affidavit of immunization is typically required for individuals who need to provide proof of their immunization status. This includes students enrolling in schools or colleges, employees in certain healthcare or childcare settings, and individuals applying for certain visas or travel permits.

What is CCA-1163A. Affidavit of immunization Exemption- For Household Members Age 13 and Younger Form?

The CCA-1163A. Affidavit of immunization Exemption- For Household Members Age 13 and Younger is a writable document which can be completed and signed for specified purpose. Next, it is furnished to the relevant addressee to provide some details of any kinds. The completion and signing is able or using a trusted solution like PDFfiller. Such tools help to submit any PDF or Word file online. It also allows you to customize its appearance for your needs and put a valid electronic signature. Once finished, the user sends the CCA-1163A. Affidavit of immunization Exemption- For Household Members Age 13 and Younger to the recipient or several ones by email and also fax. PDFfiller has got a feature and options that make your Word template printable. It has various options when printing out. It doesn't matter how you file a document - physically or electronically - it will always look neat and organized. To not to create a new file from the beginning all the time, make the original form into a template. After that, you will have a rewritable sample.

Template CCA-1163A. Affidavit of immunization Exemption- For Household Members Age 13 and Younger instructions

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CCA-1163A. Affidavit of immunization Exemption- For Household Members Age 13 and Younger: frequently asked questions

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The cca-1163a affidavit of immunization is a legal document that certifies an individual's immunization status.
All individuals, including students and employees, are required to file cca-1163a affidavit of immunization.
To fill out the cca-1163a affidavit of immunization, one must provide information about their immunization history and sign the document.
The purpose of cca-1163a affidavit of immunization is to ensure that individuals are properly immunized to prevent the spread of infectious diseases.
The cca-1163a affidavit of immunization must include information about the vaccines received, dates of administration, and healthcare provider information.
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