Schedule AI, the undersigned, hereby certify that, in my opinion, the

Schedule A

SCHEDULE A (See section 5) I, the undersigned, hereby certify that, in my opinion, the child of , resident at , is not now in a fit and proper state to be vaccinated, and I do hereby recommend that the vaccination be postponed for the period of one month from this date. Dated the day of 19 (Signature of Medical Practitioner or Inspector.) ______