Report a School Vaccination

Has your child received the H1N1 vaccination at school? If so, please use this form to tell us about it so that we can update your child's medical records.

Your E-Mail Address (Required)

Name of Child (Required)

Child's date of Birth (Required)

/ /

What school does your child attend? (Required)

What type of vaccine did your child receive? (Required)

Flu Mist
Injection

Date of vaccination (Required)

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Report a School Vaccination