2020 STUDENT Tdap VACCINATION CONSENT FORM-2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling in your child's name, including last, first, and middle names. Ensure you also provide the date of birth and age.
3. Indicate the gender of your child by selecting either 'M' for male or 'F' for female.
4. If your child is a minor, enter the parent or guardian's name along with their date of birth and Social Security Number (optional).
5. Complete the address section with your home address, city, ZIP code, and school details including grade and homeroom teacher.
6. Provide important contact numbers: home, cell, and work phone numbers for the parent/guardian.
7. Answer the health questions regarding allergies and previous vaccine reactions by checking 'YES' or 'NO'.
8. Fill out insurance information if applicable. Indicate if your child is uninsured or covered by Medicaid/FAMIS.
9. Sign the consent section at the bottom of the form to authorize vaccination for your child.

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