Lauderdale County School District

Together Empowering Students for Success

STUDENT PEEHIP Flu Vaccine Program 2022

PEEHIP Flu Vaccine Program for Students

The Alabama Department of Public Health will offer the Flu Shot to students age Pre K-4 years through 12th grade that have PEEHIP Insurance (BC/BS insurance number that begins with EDU). This school vaccination program is voluntary and parents must complete the attached permission form and return to the school nurse one week before the school clinic.

Parent Reminders for filling out flu form:
1. Please use black ink only!
2. Please make sure all boxes are filled out correctly.
3. Under patient information, please make sure to put the last four of the child who is receiving the vaccine's social. Not the parents.
4. Please answer all of the yes/no questions.
5. Please sign and date the form. The vaccine can not be administered without a signature.
6. Forms must be original and turned in to the Alabama Department of Public Health Vaccination team by the school nurse on the day of the clinic. We can not accept emailed or faxed copies. Must have that original signature.

ADPH Student Consent Flu Vaccine Form 2022

ADPH Flu Vaccine Information Sheet 2022

Lauderdale County Schools does not discriminate in admission, treatment, or access to programs or activities based on race, color, national origin, religious preference, disability, age, gender, sexual orientation, citizenship, non-English speaking ability, or homeless status and provided equal access to the Boy Scouts and other designated youth groups. Students with disabilities will be provided with the same needed supports and services for extracurricular programs and activities that are provided during the school day, unless doing so would fundamentally alter the nature of the program and activity. The following person has been designated to handle inquiries regarding the non-discrimination policies: Mr. Tim Tubbs, Lauderdale County Board of Education, 355 County Road 61, Florence, AL 35634. Phone: (256) 760-1300. Email: tim.tubbs@lcschools.org.