Flu Clinic Fall, 2012

Dear Parents/Guardians:

We will once again be able to provide the student flu vaccine on Wednesday, November 7th.  If you wish to have your child vaccinated here, you must do these four steps.



**Note that download links to all forms at the bottom of this page**

  1. Sign your child up using online form below,  listing your child’s name, your name and your email address, phone number and teacher.  This will alert me that you have signed up your child, so I can contact you if I do not get a returned permission form at school.
  2. Download the Vaccine Information Statements  (below) for either the intranasal vaccine or the injectable vaccine and read it carefully.
  3. Download the Health Screen and Permission Form (below) and answer ALL the questions and fill in EVERY box.  If the form is not completed, it will need to be returned to you and this may delay vaccine administration. Insurance does not get charged for this vaccine,  since this is from the State, but the information is needed to input date into the Maine Immunization Registry.
  4. Send the completed permission form to school with your child by Monday, November 5th, 2012. We will NOT be able to accept any permission forms after November 5 due to vaccine ordering that needs to be done beforehand.
If you have difficulty downloading forms, you can pick them up either the Conners or Emerson Front Office.


Sincerely,

Donna Coleman, RN

School Nurse


Google Spreadsheet Form

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Rick Barter,
Oct 22, 2012, 6:23 AM
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Rick Barter,
Oct 22, 2012, 6:21 AM
Ċ
Rick Barter,
Oct 22, 2012, 6:21 AM
Ċ
Rick Barter,
Oct 22, 2012, 6:21 AM
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