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CONSENT FORM

‘Unlicensed’ explained:

The Medicines and Healthcare products Regulatory Agency (MHRA) is the body responsible for issuing licences for the manufacture and sale of vaccines in the UK and also for issuing licences for the importation of vaccines into the UK. 

The measles, mumps and rubella as single vaccines are unlicensed for manufacture and sale in the UK. 

However, single vaccines are manufactured in Europe and the USA and are licensed to be imported into the UK by the MHRA. The manufacturer of these vaccines is responsible for their efficacy and safety under the Consumer Protection Act 1987, subject to them being stored and administered correctly.

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 I/we .......................................................................................................................  being

 the parent/s/legal guardian/s of ............................................................................... hereby give consent to vaccinate the aforementioned child with separate vaccines of measles/mumps/rubella, under the supervision of Dr Nick Arundale.

I/we confirm that I/we have read and understood fully the above definition relating to ‘unlicensed’ use of vaccines.

I/we also confirm that unless my/our child is immunised using measles, mumps and rubella vaccines separately, I/we will not have him/her vaccinated, now or in the future.

 Signed................................................................................       Dated:   ..….../.….../…....

 Signed................................................................................       Dated:   ....…./.….../…....