Sharing immunization and personally identifiable information including the student’s name, Date of Birth, gender, and address with local and state health departments will help to keep your child safe from vaccine preventable diseases. The Family Educational Rights and Privacy Act (FERPA), 20 U.S.C. § 1232g, requires written parental consent before personally identifiable information and immunization information from your child’s education records is disclosed to the health department. I authorize Byron Center Charter School to release my child’s immunization record and/or waiver, confirmation of vision screening and personally identifiable information to the Michigan Department of Health and Human Services and Local Health Department. *