CONSENT AND AUTHORITY
I declare that:
• I have been provided with, read, and understood the information given about immunisation including the risks and benefits, and I have been given the opportunity to ask questions.
• The information completed by me on this form is true and correct to the best of my knowledge.
• I am legally authorised to provide consent on behalf of the person being vaccinated.
• I request to have each vaccine or for the person to be vaccinated to have each vaccine (if applicable) and understand that it is completely voluntary.
• I consent to the immuniser collecting my personal information and that of the person to be vaccinated (if applicable) for the purpose of creating and maintaining a vaccination statement and providing a copy of the vaccination statement, including any such personal information contained in the statement, to the Australian Immunisation Register (AIR) and the nominated primary health care provider.
• I agree to remain within the vicinity of the vaccination service for 15 minutes or for the person to be vaccinated to remain within the vicinity of the vaccination service for 15 minutes (if applicable).
• I have been informed of, and agree to pay, the fees or charges associated with this service.
• I consent to emergency care if required and give permission for the immuniser or pharmacy staff to access medical care on my behalf or on behalf of the person to be vaccinated (if applicable). I understand that I am responsible for any costs associated with any emergency care.