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I'm Form Annual Influenza Vaccine Consent Form FLU SHOT 20142015 Section 1: Information about Child to Receive Vaccine (please print) STUDENTS NAME (Last) (First) (M.I.) STUDENTS DATE OF BIRTH month
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How to fill out fluconsentform201415doc - stdomsmaine
How to fill out fluconsentform201415doc - stdomsmaine:
01
Start by entering your personal information, including your full name, date of birth, and contact information.
02
Provide your medical history, including any known allergies, current medications, and previous flu vaccinations.
03
Indicate your flu vaccine preference, if applicable.
04
Sign and date the form to confirm that all information provided is accurate and complete.
Who needs fluconsentform201415doc - stdomsmaine:
01
Students or individuals attending St. Dominic's School in Maine who are required to receive a flu vaccine.
02
Parents or legal guardians of students attending St. Dominic's School in Maine, who need to provide consent for their child to receive the flu vaccine.
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What is fluconsentform201415doc - stdomsmaine?
fluconsentform201415doc - stdomsmaine is a consent form for flu vaccination for the year 2014-2015 at St. Dominic's Maine.
Who is required to file fluconsentform201415doc - stdomsmaine?
Parents or legal guardians of children attending St. Dominic's Maine during the flu vaccination period are required to file fluconsentform201415doc - stdomsmaine.
How to fill out fluconsentform201415doc - stdomsmaine?
To fill out fluconsentform201415doc - stdomsmaine, parents or legal guardians need to provide their child's information, their consent for flu vaccination, and any relevant medical history.
What is the purpose of fluconsentform201415doc - stdomsmaine?
The purpose of fluconsentform201415doc - stdomsmaine is to gather parental consent for their child to receive the flu vaccination at St. Dominic's Maine.
What information must be reported on fluconsentform201415doc - stdomsmaine?
Information such as the child's name, age, grade, medical history (especially related to allergies or previous vaccinations), and parent or guardian contact information must be reported on fluconsentform201415doc - stdomsmaine.
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