This school as a Public Secondary School will conduct the School Based Immunization (SBI) Program This school as a Public Secondary School will conduct the School Based Immunization (SBI) Program to the grade 7 students in coordination with the Rural Health Unit (RHU), Department of Health to the grade 7 students in coordination with the Rural Health Unit (RHU), Department of Health (DOH) and the Local Government Unit (LGU). (DOH) and the Local Government Unit (LGU).
Very truly yours, Very truly yours,
Adviser Adviser
PARENT’S CONSENT PARENT’S CONSENT
DATE: __________________ DATE: __________________ STUDENT’S NAME: ___________________________ GRADE & SECTION: _______________________ STUDENT’S NAME: ___________________________ GRADE & SECTION: _______________________ NAME OF PARENT/GUARDIAN: ______________________________________ NAME OF PARENT/GUARDIAN: ______________________________________ SCHOOL: _______________________________________ SCHOOL: __________________________________________________ This is to acknowledge receipt of the Notification Letter regarding the conduct of School – This is to acknowledge receipt of the Notification Letter regarding the conduct of School – Based Immunization Based Immunization . YES, I will allow my child to be immunized. YES, I will allow my child to be immunized. NO, I will not allow my child to be immunized. Reason/s: ___________________________________________________________ NO, I will not allow my child to be immunized. ____________________________________________________________ Reason/s: ___________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ______________________________ Name & Signature of Parent Guardian ______________________________ Name & Signature of Parent Guardian