To: By Certified Mail
________________ School
Legal Department
______________________
______________________
______________________
NOTICE OF WARNING REGARDING UNDISCLOSED VACCINATIONS
As the parent of ______________________ I hereby instruct any and all persons associated with____________________ school that no injections, vaccines, or inoculations of any kind shall be administered to my child without my express knowledge and written consent. Any violation of my wishes for informed consent so clearly expressed may result in civil and criminal actions being initiated against any and all parties directly or indirectly responsible for such unauthorized medical procedures, to the fullest extent of the law.
Signed and witnessed this __________________________________
Date
Parent
__________________________ __________________________________
Sign print
Witness
_____________________
Sign
___________________
print
