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To the J&K Healthy Choice and its affiliates, vaccine appointment and authorize J&K Healthy Choice to administer the COVID-19 vaccine to my child in my absence
I GIVE CONSENT for the child named at the top of this form to get vaccinated with the COVID-19 Vaccine and reviewed and agree to the information
For 12- through 15-years-olds who will not be accompanied by their parent or legal guardian only
If you check this box, you may be asked to attest to this at your vaccine appointment
NAICS #621999NPI #1851970156
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