FSCC Dorm Medical Information Form

 
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IN CASE OF EMERGENCY CONTACT:
MUMPS & MEASLES
MENINGITIS

FSCC recommends that all students living in the dorm have a meningitis vaccination. Before a student can move into the dorm, he/she must provide a copy of his/her meningitis vaccination record or sign the waiver below.

If YES, a copy of your meningitis vaccination record must be on file with FSCC. If NO, read and sign the following.

I understand that meningitis is an infection that causes inflammation of the brain and spinal cord and can cause serious illness and permanent disabilities (such as deafness, limb amputation or death). Furthermore, I acknowledge that FSCC has recommended that I receive the meningitis vaccination. However, I do not choose to be vaccinated for this disease and release FSCC from any liability for illness or disabilities resulting from meningitis, should I contract the disease.