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Covid-19 Vaccine Permission for Students 16+
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Email
*
Your email
This form is to give permission for your student 16+ to receive the Covid vaccine to be administered April 8th.
Your Name
*
Your answer
Student Name
*
Your answer
Student Date of Birth
*
Your answer
Your Phone Number (We will TEXT the Appointment Time)
*
Your answer
Additional Phone number to be contacted (Student's phone number)
Your answer
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This form was created inside of Arkansas School for the Deaf.
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