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30 Day Exemption Request Form
If you need a 30 day exemption for your child to receive their Tdap shot, please fill out the form below.
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* Indicates required question
Student Last Name
*
Your answer
Student First Name
*
Your answer
Student Middle Initial
*
Your answer
Parent's Name (First & Last)
*
Your answer
Address
*
Your answer
Telephone Number
*
Your answer
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