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Get Affidavit Immunization Print Out Form

Er 18, name of parent, guardian, or other person responsible for student s care and custody: Street address and city: Telephone: (home) (work) I, the undersigned, swear or affirm that immunization against diphtheria, pertussis (whooping cough), tetanus, polio, rubella, mumps and measles is contrary to my religious tenets and practices. I a.

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