Get Vaccine Declination Form - University Of Massachusetts Boston

Completing the Vaccine Declination Form is an important step for students at the University of Massachusetts Boston who choose to decline recommended vaccinations. This guide will provide you with a clear, step-by-step approach to filling out the form accurately and efficiently online.

Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering your name in the 'Name (print)' field. Make sure to provide your full legal name as it appears in official documents.
3. Next, input your date of birth (DOB) in the designated field. Use the format MM/DD/YYYY to ensure clarity.
4. Enter your student ID in the 'Student ID' section. This helps the university identify your record accurately.
5. Review the list of vaccines. For each vaccine recommended by your health provider and the Massachusetts Department of Public Health, select the appropriate box in the 'Declined' column to indicate your choice.
6. Read the Vaccine Information Statement provided in the form. Acknowledge that you understand the purpose, risks, and benefits of the recommended vaccines.
7. Confirm that you have discussed your decision with your health provider and have been informed of the consequences of declining vaccinations.
8. Sign the form in the designated 'Signature' section. This signature must be your own and it indicates your acknowledgment of the contents herein.
9. Finally, enter the current date next to your signature. This date should be the date on which you are submitting the form.
10. If applicable, have your health provider sign the form in the 'Provider Signature' field and date it accordingly.
11. After filling out all the required fields, ensure all information is accurate. You can now save your changes, download, print, or share the completed form.

Complete your Vaccine Declination Form online today to ensure your compliance with university requirements.