1. I understand that it is recommended to avoid this vaccine until 14 days have passed after other vaccine(s).
2. I understand that it is recommended that I avoid any routine vaccinations for my child in the next two weeks.
3. I have reviewed and completed the Pre-Vaccination Checklist for COVID-19 Vaccines for my child.
4. I have received and read the FACT SHEET FOR RECIPIENTS AND CAREGIVERS EMERGENCY USE AUTHORIZATION (EUA) OF THE PFIZER-BIONTECH COVID-19 VACCINE TO PREVENT CORONAVIRUS DISEASE 2019 (COVID-19) IN INDIVIDUALS 16 YEARS OF ACE AND OLDER, dated April 6, 2021. I understand the risks and benefits, and give consent for my child to recive the Pfizer COVID-19 vaccine. In, addition, I have received information regarding the Hawaii Immunization Registry.
5. I affirm that I am the parent or legal guardian of the child named at the top of this form.