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Get Jefferson Statement of Exemption to College and University Student Vaccination Act

___________________________ Date of Birth ______________ Parent or Guardian name (if under 18) ____________________________________________________ Address ____________________________________________________________________________ Telephone ( ) _____________________ I have been given a copy and have read, or have had explained to me, the information in the Meningococcal Vaccine Information Statement for meningococcal disease. I have had a chance to ask questions that were answered to my sa.

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How to fill out and sign Jefferson Statement of Exemption to College and University Student Vaccination Act online?

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