Delegation of Authority to Consent to Immunizations (a parent/guardian may give authority to another adult [18 years and older] to consent to immunize their child in the parent/guardian's absence).
I, Parent/Guardian* , authorize and consent for Adult Bringing Child* to bring my child Child's Name* to the Platte County Health Department's Vaccine Clinic to receive their immunization(s). I agree for my child to receive their vaccine(s) and verify that I have read the Vaccine Information Statement for each vaccine they are to receive here and/or the Emergency Use Authorization for their COVID-19 Vaccine here.