Trumbull Pre-School Flu Requirement 2022-2023

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

According to our records you have a Pre-School Aged Child attending Trumbull Schools

State of Connecticut Department of Public Health guidelines mandate all children 24 months to 59 months who attend school must receive an annual flu vaccination: 1 dose administered each year between August 1st-December 31st of the current school year or 2 doses separated by at least 28 days for those receiving flu vaccine for the first time.

Children who have not provided proof of Immunization for flu by December 31st 2022 must be excluded from school for the duration of the influenza season (through March 31st)

Please complete the following survey for your school nurse to confirm your awareness of this requirement.

When you have proof of immunization for the flu please send to the nurse as soon as possible.

Student Name *

School *

TECEC

St. Theresa School

St. Catherine of Siena

Grade *

Pre-K 3

Pre-K 4

Pre-K 5

Please answer the following re: your child's flu immunization status.

My Child:

Already received a dose(s) of flu vaccine this school year after 8/1/22

Has an appt to receive required dose(s) of flu vaccine before 12/31/22

Will get an appointment to recive the required dose(s) of flu vaccine before 12/31/22

Will not be getting the flu shot and will not attend school 12/31/22 through 3/30/23

Date of Appointment for Flu Vaccine *

YYYY

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Trumbull Public Schools.

Does this form look suspicious? Report

Forms