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300 East 27th Street | North Newton, KS 67117 bethinks. Meningitis VACCINATION RECORD/WAIVER FORM NAME ID #DATE OF BIRTHCAMPUS ADDRESS CELL PHONEME PHONEMIC ADDRESSoHarvey County Health Department
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How to fill out meningitis vaccination recordwaiver form

01
Get a copy of the meningitis vaccination record waiver form.
02
Fill out your personal information such as name, date of birth, and contact information.
03
Indicate if you have received the meningitis vaccination by providing the date and location of the vaccination.
04
If you are opting for a waiver, provide a reason for why you are not getting vaccinated.
05
Sign and date the form to acknowledge that the information provided is accurate.

Who needs meningitis vaccination recordwaiver form?

01
Individuals who are required to provide proof of meningitis vaccination for school or work purposes.
02
Individuals who are seeking an exemption from receiving the meningitis vaccination.
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The meningitis vaccination record/waiver form is a document used to report a person's vaccination status for meningitis.
Students attending certain schools or living in certain residential facilities may be required to file the meningitis vaccination record/waiver form.
The form typically requires the individual to provide their personal information, vaccination history, and either vaccination records or a waiver for exemption.
The purpose of the form is to ensure that individuals are appropriately vaccinated against meningitis or have a valid exemption.
The form may require personal information, vaccination history, and a signature indicating either vaccination completion or exemption.
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certificate of vaccination template 27th bethelks edu vaild ks meningococcal vaccines vaccinated availability meningitis vaccination waiver submission guardians

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