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MADERA COUNTY TRANSPORTATION COMMISSION COVID-19 VACCINATION DECLINATION FORM RELEASE AND LIMITATION OF LIABILITY FOR DECLINING TO RECEIVE THE COVID-19 VACCINE Sign and return this form only if you

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How to fill out covid-19 vaccine declination form

01

Contact your healthcare provider or employer to obtain the covid-19 vaccine declination form.

02

Read through the form carefully to understand the information required.

03

Fill out all sections of the form accurately and honestly.

04

Sign and date the form where indicated.

05

Submit the completed form to the appropriate party as per the instructions provided.

Who needs covid-19 vaccine declination form?

01

Individuals who have chosen not to receive the covid-19 vaccine.

02

Employees who are required to submit a declination form to their employer.

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What is covid-19 vaccine declination form?

Covid-19 vaccine declination form is a form used to indicate that an individual has chosen not to receive the covid-19 vaccine.

Who is required to file covid-19 vaccine declination form?

Individuals who choose not to receive the covid-19 vaccine are required to file the covid-19 vaccine declination form.

How to fill out covid-19 vaccine declination form?

To fill out the covid-19 vaccine declination form, individuals need to provide their personal information and indicate their decision not to receive the vaccine.

What is the purpose of covid-19 vaccine declination form?

The purpose of the covid-19 vaccine declination form is to document an individual's decision not to receive the covid-19 vaccine.

What information must be reported on covid-19 vaccine declination form?

The covid-19 vaccine declination form must include personal information of the individual and their decision not to receive the vaccine.

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