Liberty Career College
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Forms:

Immunization Requirements Form

immunization_blood_titer_requirements.doc
File Size: 136 kb
File Type: doc
Download File

LCC must receive copies of the blood titer results.  Booster immunizations may be needed if not showing immunity.  

Physical Form

physical_exam_form.doc
File Size: 36 kb
File Type: doc
Download File

Please ask your physician to fill out the form entirely and place the facility stamp at the bottom of the form.

Influenza Statement of Refusal Form

influenza_statement_of_refusal.doc
File Size: 121 kb
File Type: doc
Download File

Hepatitis B Declination Form

hep_b_statement_of_refusal.doc
File Size: 118 kb
File Type: doc
Download File

Tdap Declination Form
tdap_statement_of_declination.doc
File Size: 118 kb
File Type: doc
Download File

Please print out and sign the attached form if you'd like to decline the Tdap vaccination.  (LCC can provide a printed copy as well.)

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