Waiver for Canine Influenza H3N8 (CIV H3N8) vaccination First Name*Last Name*Pet's Name*Boarding Drop Off Date*Waiver of Vaccinations(s), Treatment(s), or Test(s) Statement: As owner or authorized agent of the owner of the animal described above, I have decided NOT to proceed with administering the Canine Influenza H3N8 (original strain) vaccination(s) to my pet as recommended. The reasons for the recommendation(s) have been fully explained to me as well as the risks inherent in not proceeding with them in the handout I was given. In making this decision I agree to absolve Babcock Hills Veterinary Hospital of any responsibility for the consequences of this decision. I have read and understand this waiver and I am over the age of eighteen.By providing my signature I acknowledge that I am electing to decline the Canne Influenza H3N8 vaccine. Digital Signature*Date* PhoneThis field is for validation purposes and should be left unchanged.