FORMS

Dear Parents and Guardians:

Columbus Public Health is working with our school to offer flu vaccinations for students this year. This vaccine clinic is an easy and convenient way for your child to be protected against the flu.

School:  St. Francis DeSales High School
Clinic date:  October 18, 2016
Turn in form by: Friday, September 23
Return form to:  Assistant Principal, Jim Jones

To sign your child up for our school clinic, please read the attached Vaccine Information Statement (VIS) and complete the attached consent form. The form must be signed by the child’s parent or legal guardian and all health questions must be answered.
   
Nurses from Columbus Public Health (CPH) will be giving the vaccine. Please note however, that due to low effectiveness against influenza A in the U.S. during the 2013-14 and 2015-16 seasons, CPH is following the Centers for Disease Control and Prevention (CDC) and Advisory Committee on Immunization Practices’ (ACIP) recommendation that the FluMist (nasal spray) vaccine not be used. As a result, Columbus Public Health will only offer the injectable (shot) flu vaccine. After the vaccine is given, your child will bring home a card from Columbus Public Health with the date given. 

Medicaid and private insurance is billed when possible, but you will not be billed. No child will be denied the flu vaccine due to inability to pay. The Vaccines For Children (VFC) Program provides free vaccines to children who are: Medicaid-eligible; without insurance; American Indian or Alaska Native; or underinsured.  

Children 8 years old and younger may need a 2nd dose of the flu vaccine to be fully protected. (The 2nd dose is given at least 1 month after the 1st dose.) Returning the attached consent form gives permission for both doses, if needed, as determined by the CPH nurse. Additionally, if your child gets the flu vaccine from another provider after you’ve returned the consent form, please send an updated vaccine record to the school to avoid a duplicate vaccine being given to your child.  

If you prefer to have your child vaccinated by your own healthcare provider, we encourage you to do so, even though we are offering it at school. The flu virus is easily spread and can cause children to miss many days of school so it is important for them to be protected.

If you have any questions, please call the CPH nurse at 614-645-5037. More information also is available at: http://columbus.gov/publichealth/.

We encourage you to take advantage of this great opportunity to protect you child from the flu this year! 

Sincerely,

 

Jim Jones
Assistant Principal