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I give permission to share my child's immunzation records including those provided to School(s) with the WIR and my Immunization Provider for the purpose of maintaining a complete and accurate record to assist in assuring full immunization.
I wish to submit this influenza administration form by electronic means. By signing this permission form, I certify, that my answers are correct and complete to the best of my knowledge. I understand the questions and statements on this permission form. I understand that an electronic signature has the same legal effects and be enforced the same way as a written signature.
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