Agreement on covid-19 vaccination

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AGREEMENT ON COVID-19 VACCINATION
(Issued together with Official Letter No. 8688/BYT-DP dated
October, 2021 of the Ministry of Health)
CONSENT FORM TO PARTICIPATE IN COVID-19 VACCINATION
1. Vaccination is an effective way to prevent disease, but may not completely prevent the disease.
Receiving a full dose of COVID-19 vaccine can prevent or reduce the severity of the disease if
people are infected with COVID-19. After being vaccinated against COVID-19, it is necessary to
fully comply with the 5K Message on COVID-19 prevention and control.
2. Vaccination against COVID-19 may cause some symptoms at the injection site or the whole
body such as swelling, pain at the injection site, headache, nausea, fever, muscle pain,... or
serious complications after injection.
3. When having abnormal health symptoms, the vaccinated person should contact the nearest
medical facility for timely advice, examination and treatment.
After reading the above information, I understand the risks and:
Agree to let my children get vaccinated 
☐
Disagree to let my children get vaccinated 
☐
Name of parent or guardian: ..........................................................................................................
Phone number: ...............................................................................................................................
Name of child to be vaccinated: ...................................................................................................
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Parents or guardians
(Sign, write full name)