The Northampton School Department, partnering with the Northampton Health Department, will
once again offer the seasonal flu vaccine shots at JFK Middle School and Northampton High
School. We make this vaccine available to our school-age children because this age group
usually has a significant number of flu cases, and the flu virus spreads quickly in the school
setting. The flu shots are free, however we will ask for your health insurance information in
order to submit for reimbursement for the administration of the vaccine.
Northampton High School 10/24/2017
JFK Middle School 10/25/2017
Enclosed in this packet are the seasonal flu vaccine information statement (VIS) and the consent
and insurance forms. Please read the VIS carefully and call your health care provider or the
school nurse at your school with any questions. If you decide to have your student(s) vaccinated
at school, please complete the consent and insurance forms and return to your
school by Friday, October 20, 2017.
Be sure to complete the screening questions on the reverse side of the consent
form and sign your consent on the front.
*NO VACCINE WILL BE ADMINISTERED TO A STUDENT WITHOUT A COMPLETED AND SIGNED CONSENT /INSURANCE FORM.*
Karen Jarvis Vance, Director of School Health Services
Jenny Meyer BSN, RN, Public Health Nurse