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Year 10 Secondary School Vaccine Program Consent Form

How to complete the form

  • Please read the Meningococcal ACWY information and the information in the vaccine consent form.
  • Complete the vaccine consent section and type your name to consent to the vaccine
  • Complete the consent sections even if you do not want your child to be vaccinated

Meningococcal ACWY information

Pre-immunisation checklist

Before you or your child is immunised, tell your doctor or nurse if any of the following apply.

  • Is unwell on the day of immunisation (temperature over 38.5°C)
  • Has any severe allergies
  • Has had a severe reaction to any vaccine
  • Is pregnant

After vaccination wait at the place of vaccination a minimum of 15 minutes.

Further information

If you require further advice or information, please contact your local council immunisation service or local doctor.

Or visit the Better Health Channel website

Translating and interpreting service call 131 450

Consent form

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