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School Influenza Clinic Consent Form FOND DU LAC COUNTY HEALTH DEPARTMENT 160 S MACY ST, FOND DU LAC WI, 54935 (920)9293085 Authorization to Receive 20132014 Attenuated Influenza Vaccine () or Inactivated
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How to fill out school influenza clinic consent

How to fill out school influenza clinic consent:
01
Obtain the consent form: First, locate the school influenza clinic consent form. This can typically be obtained from the school nurse or the school administration office.
02
Read the instructions: Before filling out the form, carefully read the instructions provided. Make sure you understand the purpose of the consent form and any specific requirements or guidelines mentioned.
03
Fill out personal information: Begin filling out the form by providing your personal information. This usually includes your full name, date of birth, grade, and contact information. It is important to provide accurate information to ensure proper identification.
04
Provide emergency contact details: Next, provide the name and contact information of an emergency contact person. This should be someone who can be reached in case of any complications or emergencies during the influenza clinic.
05
Answer health-related questions: The consent form may have questions related to your health, medical history, and any allergies or sensitivities you may have. Answer these questions truthfully and accurately to ensure the clinic staff can provide appropriate care.
06
Indicate consent: Look for a section on the form where you can indicate your consent to participate in the school influenza clinic. This is usually a checkbox or a signature line. If you agree to participate, make sure to indicate your consent as instructed.
07
Parent/guardian signature: If you are under 18 years of age, you will likely need a parent or guardian's signature on the form. Make sure to have them review the consent form and sign it accordingly.
08
Return the form: Once you have filled out the consent form and obtained the necessary signatures, return the form to the designated location as instructed. This may be the school nurse's office or a specific drop-off location.
Who needs school influenza clinic consent?
01
Students: In most cases, school influenza clinic consent is required for students who wish to receive the influenza vaccination within the school premises. This helps ensure that students receive the necessary medical care and helps prevent the spread of influenza within the school community.
02
Parents or guardians: If the student is under 18 years of age, a parent or guardian typically needs to provide consent on behalf of the student. This ensures that they are aware of the vaccination and have given permission for their child to participate in the clinic.
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What is school influenza clinic consent?
School influenza clinic consent is a form that allows parents or guardians to give permission for their child to receive a flu vaccine at a school clinic.
Who is required to file school influenza clinic consent?
Parents or guardians of students who wish for their child to receive a flu vaccine at a school clinic are required to file school influenza clinic consent.
How to fill out school influenza clinic consent?
School influenza clinic consent can typically be filled out by providing basic information about the student, parent/guardian contact information, and signing to give consent for the flu vaccine to be administered.
What is the purpose of school influenza clinic consent?
The purpose of school influenza clinic consent is to ensure that parents or guardians are aware of and approve their child receiving a flu vaccine at a school clinic.
What information must be reported on school influenza clinic consent?
School influenza clinic consent may require information such as student name, date of birth, parent/guardian contact information, and signature for consent.
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