All students must have a signed consent form to get vaccinated.
In order to help keep all students safe and healthy, it’s necessary we take proper precautions. That’s why all students who receive the flu vaccine at school must have a signed consent form.
The form provides important health information to help the nurses make the appropriate decisions when caring for your student. We do request health insurance information, but it is only for the purpose of better understanding the communities we serve. Health insurance is not required and insurance companies will not be billed. Students are eligible to receive the vaccine for free with or without insurance.
If you need assistance reviewing the information, please call Alameda County Public Health Department at (510) 267-3230.
Download & Print the Consent Form
- A PDF of the consent form will open in a new window.
- Print and fill out the consent form.
- Return it to your school.
Adobe Reader is required to access this form. Don’t have it? No problem. Download it here:
The consent form is available in 5 additional languages. Click below to download and print the version you need:
- Inactivated Influenza Vaccine Information Statement
Contains important information about the injection form of the flu vaccine (the flu shot).
Explains how your student’s information will be protected by the Alameda County Public Health Department.
- California Immunization Registry (CAIR)
CAIR is a confidential and secure computer system that makes vaccination information available to healthcare providers. Shoo the Flu will enter all vaccination records in CAIR as allowed by law. Unless you note otherwise on the consent form, Shoo the Flu will also make your student’s vaccination record available for healthcare providers to review.