Flu Clinic (Students) 9.26.22
If you would like your child (7th-12th Grade) to participate in the flu clinic on Monday, September 26th please complete this form so that we know approximately how many students (7th-12th) will be receiving their vaccination.

You will also need to complete the  Flu Shot Consent form and send a copy of their insurance card to school with them.   You can download the consent form at  https://5il.co/1iftl


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Email *
Name of Student *
Current Grade Level *
Name of Parent/Guardian completing this form *
Phone Number *
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