Dear Parents and Guardians,
In partnership with the Arkansas Department of Health (ADH), our school will participate in a flu immunization clinic that provides free flu vaccine for scholars, faculty, and staff on Friday, October 21.
For your scholar to receive the flu vaccine, you must:
1. Read the Vaccine Information Statement for the vaccine.
2. Read and complete the front and back of the ADH consent form (last page of flu packet).
3. PRINT clearly all information required on the ADH consent form.
4. Make sure you have signed the ADH consent form for the flu vaccine.
5. Sign the school (FERPA) consent form IF it was not signed on the Scholar Health History form returned to the nurse.
6. Return both consent forms to your scholar’s school as quickly as possible.
BOTH forms (ADH consent and FERPA) need to be returned to Ms. DeSpain by Wednesday, October 18th. If you signed the FERPA form on the Scholar Health History form, you do not need to sign again.
This is a great opportunity for scholars to receive this vaccine with no charge to you. If you have insurance, ADH will ask your insurance company to pay for the cost of giving the vaccine. If you do not have insurance or your insurance does not pay for vaccines, there will still be no charge to you.
Flu consent packets are available now for pick up in Ms. DeSpain’s office. Please email Ms. DeSpain at firstname.lastname@example.org if you have any questions.