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Get Immunization Form - Student Affairs, Macon Campus - Mercer ... - Studentaffairs Mercer

Being removed from classes. Once completed, mail to Mercer University, Student Health Center, 1400 Coleman Avenue, Macon, Georgia 31207 or by Fax: (478) 301-2116 or by e-mail: shcmacon mercer.edu. Date: SS# - - Name: Student ID # Birth Date: (Last) (First) (Middle) Age: Phone :( ) (MM / DD / YYYY) Home Address: (Street) Emergency Contact Person: (City) (State) (Zip) Relationship to you: Address of Contact: Phone:( Parental/Guardian consent for medical care of student -- (If.

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