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This document is a Certificate of Exemption (COE) form from immunization requirements for school, daycare, and preschool attendance in Washington. It collects information about the child such as name, date of birth, and parent/guardian contact details. The parent/guardian can choose exemptions for medical, personal, or religious reasons and sign the form, or a healthcare provider with prescribing authority can sign for a medical exemption. The bottom notes that Washington state law requires schools and chil
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