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Immunization clinic 5/14/2025

Parents/Guardians,

The Sarcoxie R2 School District will be offering an immunization clinic in partnership with the Jasper County Health Department on May 14th at 5:30 pm in the High School Cafeteria. The immunizations available will include TDAP and Meningococcal for ages 11-14 and Meningococcal booster for ages 16-18. Please be sure to bring the child's shot record with them. These are required school vaccinations.

Please pre-register using this google form. Please register each child individually by May 7th.

After you have pre-registered, print off the Permission Form found online and fill it out for your child.  Each child must have a signed permission form with them in order to receive the immunizations.

If you have any questions or need help to register please contact the nurse's office at 417-548-3421 ext 204.


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Child's Name *
Date of Birth *
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/
DD
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Tdap and Meningococcal (Ages 11-14 years old) *
Meningococcal booster (Ages 16-18 years old) *
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