I have been given a copy and have read, or have had explained to me, the information provided by the Centers for Disease Control (CDC) for the COVID-19 vaccine I/my child am to receive today.
I have had a chance to ask questions and they have been addressed to me satisfaction.
I understand the benefits and risks of the COVID-19 vaccine to be given.
I give my consent for the COVID-19 vaccine to be given to me/my child at this time.