I have been offered a copy of the Vaccine Information Statement(s) (VIS) checked. I consent to inclusion of this immunization data in the Kansas Immunization .
Immunization Consent Form. Name (as it appears on. Do you have allergies to medications, food, a vaccine component, or latex? Yes, No. Have you ever had .
CONSENT FORM–TEMPLATE. of age who have NOT been previously vaccinated with seasonal influenza vaccine, is this the first or second dose of seasonal .
August 2018. Immunisation Consent Form–template. PERSON TO. consent for the above named to be vaccinated with the vaccines ticked below. I understand.
Parental/Guardian Consent form for Immunizations. 1. I am the legal parent/