COVID 19 INFO CELL
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
DECLARATION AND CONSENT
I, ……………………………………., father/mother of …………………………………….. studying in your school in Class.…section.… agree to certify that my child is not COVID positive and my child has my consent to attend the school.
Name of Parent Mr. / Ms…………………………………………….…………….Sign with
Mob. No.__________________
date ……………………………