Waiver of Meningococcal Meningitis Immunization

I have chosen not to be immunized. My electronic signature below signifies that I have received and read the information provided to me on meningitis by Manhattan Christian College.

Student Name*
First Last
Student Email*
MCC email address is preferred if possible.
Student's Electronic Signature*
Please time your full name (first, middle initial, last)
Today's Date*
Electronic Signature of Parent or Guardian
Required if student is under 18 years of age at time of submission
Today's Date
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