Student Immunization Clinic Registration
UPDATE: Sept. 9, 2024 (at UCHS) Clinic is being rescheduled. Please check back for new date/time.

Thank you for registering your child for an upcoming FREE K-12 student immunization clinic in The School District of University City (does not include pre-school immunizations).

Please specific your preferred clinic date, time frame and immunizations needed (see flyer below for State Regulations regarding immunizations. (Be prepared to upload PDF/JPG of immunization record if you need assistance in deciding which immunization(s) to request.)

Consent forms are required. Please click on the appropriate form below, download to your computer and open the PDF file to complete and save the form. Then email with your child's immunization records to your school nurse. 

If you have questions, please contact their school nurse directly:
- Barbara C. Jordan Elementary - Ramona Symonette at rsymonette@ucityschools.org
- Flynn Park Elementary - Lakesha Mayfield at lmayfield@ucityschools.org / Tamara Bartley at tbartley@ucityschools.org
- Jackson Park Elementary Tamera Bartley at tbartley@ucityschools.org
- Pershing Elementary Olivia Anderson at oanderson@ucityschools.org
- Brittany Woods Middle - Cristin Latimore at clatimore@ucityschools.org
- University City High School/LLC - Adrienne Wilson at aWilson@ucityschools.org 
- District Lead Nurse - Pat Wilson at pwilson@ucityschools.org

For more information about state-required immunizations, visit www.ucityschools.org/Immunizations.

Please submit a separate registration for each student needing immunizations. Upon submission, please watch for an email from "Google Forms" with a copy of this registration for your personal use.

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Email *
Parent/Guardian/Caregiver Full Name *
Best Email *
Best Daytime Phone *
Student's First Name *
Student's Last Name *
Clinic Choice *
Grade level for Fall 2024 *
School for fall *
Please choose your child's school for Fall 2024. NOTE abbreviations: BCJ=Barbara C. Jordan Elementary School, FP=Flynn Park Elementary School, JP=Jackson Park Elementary School, Pershing Elementary School, BWMS=Brittany Woods Middle School, UCHS=University City High School, LLC=Lieberman Learning Center, AEL=Adult Education and Literacy Program
Immunization(s) needed *
Required
Consent Forms & Immunization Records *
The following have been sent via email or personally delivered to my child's school nurse listed above:
Required
Additional Comments
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