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Annual Human Papillomavirus (HPV) Vaccination Opt-Out Certificate

Instructions for completing HPV Vaccination Opt-Out Certificate (Return Completed Certificate to school, keep copy of information sheet for your reference)


Section 1: Before signing, read the information sheet on HPV Vaccine.

Section 2: Parent/guardian or student (if 18 years of age or older) sign and date after reading the HPV Information Statement. 



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Section 2: Student Information

Answer Required
My child's health care provider recommended the HPV vaccine.*
Answer Required
Confirmation Email