Please Return this  Signed Form   to the School Office

Booster Shot Required for 12th Grade

Shots

4TotsnTeens

Shots 4 Tots n Teens is a walk-in immunization clinic for children birth-IS years of age.
ALL INSURANCES ACCEPTED.
Cash. checks.and credit cards accepted/
8 convenient locations!

LucasCountyHealth.com
OR  419-2 13-4121

Parents are encouraged to make an  appointment now with their child's doctor or visit a Shots 4 Tots n Teens immunization clinic.

Ohio School Vaccination Requirements include a booster shot of
Meningitis vaccine for all children entering the 12th grade. Please plan now to make sure that your child is up-to-date.

Required Vaccinations:

Meningitis Vaccil).e-protects against bacterial meningitis

It is recommended at 16 years of age.
(Only one dose is needed if first dose was given after the
16th birthday.)

Recommended Vaccinations:

•	HPV (Human Papillomavirus) -protects against cervical cancer in girls and genital warts in boys.

• 	Varicella Booster- protects against Chickenpox. A booster dose is recommended if child has received only 1previous dose.

I verify that this student-----------------------

(name)

Has received Meningitis vaccine on-------------------

(date)
Signed: 	

Must be signed by the medical professional. Forgery of a medical personnel is against the law and will be handled accordingly.