07/17/2025
Rooks County Health Department
426 Main Stockton, KS 67669
Phone: (785) 425-7352
Fax: (785) 425-7075
Dear Parent/Guardian:
For your convenience we are now offering fillable vaccine forms for vaccines to be given at the school.
If you would like your child to receive a flu vaccine this year, please right click on the following link and open the hyperlink: SLVC Flu Consent: https://pdf.ac/43UQ98 or if you would like them to have a Flu Mist right click on the following link and open the hyperlink: SLVC Flu Mist Consent: https://pdf.ac/4pizev A form will have to be completed for each child needing a flu/flu mist vaccine. It will ask you to agree to use e-records and signatures with a check box. The form will automatically be sent to our office when you click on the finish button, and we will print it off there.
If you would like your child/children grades 7-12 to receive required and/or recommended vaccines (i.e. TdaP, Hep A, Gardasil, Meningococcal ACWY, Men B), please right click on the following link and open the hyperlink: Multi Vaccine Consent: https://pdf.ac/4d9Lab A form will have to be completed for each child needing a vaccine. It will ask you to agree to use e-records and signatures with a check box.. The form will automatically be sent to our office when you click on the finish button, and we will print it off there. Once we receive the completed forms our nurses will call you and ask you which required/recommended vaccines you would like your child to receive.
If you do not want to fill out these forms via the hyperlinks, you may call our office and have a form mailed to you or stop by our office and fill out a form. Please feel free to call 785.425.7352 and one of our staff will answer your questions.
Thank you for letting us provide these services for your child/children.
Sincerely,
Lori Eichman, RN
USD 269 School Nurse
USD 270 School Nurse
USD 271 School Nurse