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Pursuant to the Official Code of Georgia Annotated, Section 31-12-3.2, the following information is provided to all resident students at University of West Georgia. Please read this information carefully and sign below (if you are not yet eighteen years old a parent or guardian must also read and sign this form).

1. Meningococcal disease is a serious disease that can lead to death within only a few hours of onset; one in ten cases is fatal; and one in seven survivors of the disease is left with a severe disability, such as the loss of limb, mental retardation, paralysis, deafness or seizures;
   
2. Meningococcal disease is contagious but a largely preventable infection of the spinal cord fluid and the fluid that surrounds the brain;
   
3. Scientific evidence suggests that college students living in the dormitory facilities are at a moderately increased risk of contracting meningococcal disease; and
   
4. Immunization against meningococcal disease will decrease the risk of disease.

Meningitis vaccines are provided at the University Health Center for $95.00 each. If you are interested in receiving one of these vaccines contact Health Services at 678.839.6452

I have read and understood the above documentation.

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