Vaccine refusal form

Confidential declaration

By completing this form, you are acknowledging the following:

- I understand that, by not having the recommended immunisation schedule associated with my role, I may be at risk of contracting vaccine-preventable diseases

- I understand that, by not having the immunisation schedule associated with my role

- I can spread these vaccine-preventable diseases to other vulnerable children and adults

- The reason for the immunisations associated with my role