I understand the benefits and risk of the vaccine(s) being administered and have received a copy of a current vaccine infromation sheet (which will be emailed to you upon submission of this form). I understand that I can ask questions prior to administration of the vaccine and will review the VIS that will be sent to me via email after form submission. I on behalf of my heirs, executors, personal representatives, agents, successors, and assigns herby agree to release, indemnify and hold harmless Milltown Pharmacy, its subsidiaries, divisons, affiliates, agents , officers, directors, contractors , and employees from any and all claims arising out of, in connection with, or in any way related to the administration of the vaccine. I certify that I am at least 18 years old and here by give consent to pharmacists of Milltown Pharmacy to adminsiter the vaccine. I agree to wait near the vaccination locatio nfor approximately 15 minutes for obeservation by the pharmacist.