A.V. PUBLIC SCHOOL, FAZILKA, PUNJAB

Parental Consent Form for the Vaccination

I confirm that I

________________________________ am the parent/legal guardian of

__________________________________________of class _____________.

At this moment, I consent to the above child for the Vaccination(Covid-19) .

I understand and authorize AVPS, Fazilka to vaccinate my child through the Fazilka Health Service, Punjab, under emergency use authority.

Name:(CAPITAL LETTERS)_________________________________________

Signature _____________________________________

Contact Details

Name of Child__________________________________________

Address_______________________________________________

_______________________________________________

Parent’s Mobile Phone No. ________________________________

Emergency Contact No. (1)________________________________

Please also include all medical details relevant to the child safely, such as allergies, medication, special needs, etc.

Jan27, 2022,1840hrs

To

*The students & their Families *

Age-15 to 18 years

Vaccinate youth Fazilkas at the AVPS premises.

COVID-29 VACCINATION FOR CHILDREN AGED 15-18

Schedule

10:00 a.m. Onwards

At school premises

Note- Wear Mask, come along with your parent 👪 _

_ Follow Covid-19 Protocol _

Be Vaccinated

RamanWatts

Chairman

Sangeeta

Principal

And Team