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Scanned Document...I decline the vaccine(s) offered to the minor today due to religious/cultural beliefs/conscientious/other exemption. Decline Parent / Legal Representative Initials

Aug 08, 2021

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Page 1: Scanned Document...I decline the vaccine(s) offered to the minor today due to religious/cultural beliefs/conscientious/other exemption. Decline Parent / Legal Representative Initials
Page 2: Scanned Document...I decline the vaccine(s) offered to the minor today due to religious/cultural beliefs/conscientious/other exemption. Decline Parent / Legal Representative Initials
Page 3: Scanned Document...I decline the vaccine(s) offered to the minor today due to religious/cultural beliefs/conscientious/other exemption. Decline Parent / Legal Representative Initials
Page 4: Scanned Document...I decline the vaccine(s) offered to the minor today due to religious/cultural beliefs/conscientious/other exemption. Decline Parent / Legal Representative Initials
Page 5: Scanned Document...I decline the vaccine(s) offered to the minor today due to religious/cultural beliefs/conscientious/other exemption. Decline Parent / Legal Representative Initials