Due to circumstances that is believed to be good and also helpful it will be determined that the parents should sign a release of information for their child to receive immunizations. And so it is with great happiness that I present to my reader the following text.

 

I ____________________________________(the name of the parent) the Mother / Father of the Child who is: (check appropriate box)

[ ] four years of age or older and not born before 1988, hereby acknowledge my son / daughter (enter name) was administered an immunization against infection of Chicken Pox; and/or

[ ] a hippie and responsible for the sixties movement or born after that and is normal, hereby acknowledge my son / daughter (enter name) was administered an immunization against infection of Small Pox.

I have made an effort to be informed about my child’s immunities and with the advances in medicine, to a greater degree, I acknowledge that I am not expected to pay a great sum of money.

Sincerely
The Parent.

Interesting Links
Article about Chicken Pox
Slumdog Millionaire Wikipedia page