Sample Vaccine Waiver for College – Hep B & Menengitis

Sample Receipt of Information Regarding Vaccines and Vaccination Waiver for
Meningococcal Meningitis and Hepatitis B

To Whom It May Concern:

In accordance with Florida Statute 1006.69, which reads as follows:

Section (1): A postsecondary educational institution shall provide detailed information concerning the risks associated with meningococcal meningitis and hepatitis B and the availability, effectiveness, and known contraindications of any required or recommended vaccine to every student, or to the student’s parent if the student is a minor, who has been accepted for admission.

Section (2): an individual enrolled in a postsecondary educational institution who will be residing in on-campus housing shall provide documentation of vaccinations against meningococcal meningitis and hepatitis B unless the individual, if the individual is 18 years of age or older, or the individual’s parents, if the individual is a minor, declines the vaccinations by signing a separate waiver for each of these vaccines, provided by the institution, acknowledging receipt and review of the information provided.

Please be advised and advise those concerned that, pursuant to Florida Statute 1006.69, I have reviewed the information provided by the school regarding meningococcal meningitis and hepatitis B and the availability, effectiveness, and known contraindications of the recommended vaccines.
In accordance with Section (2), I submit this signed waiver declining these vaccines.

Sincerely,

________________________________________

Parent or Guardian

__________________

Date