NOTIFICATION LETTER NOTIFICATION LETTER

Dear Parent/Guardian: Dear Parent/Guardian:

This school as a Public Secondary School will conduct the School Based Immunization (SBI) Program This school as a Public Secondary School will conduct the School Based Immunization (SBI) Program
to the grade 7 students in coordination with the Rural Health Unit (RHU), Department of Health to the grade 7 students in coordination with the Rural Health Unit (RHU), Department of Health
(DOH) and the Local Government Unit (LGU). (DOH) and the Local Government Unit (LGU).

Very truly yours, Very truly yours,

Adviser Adviser

PARENT’S CONSENT PARENT’S CONSENT

DATE: __________________
STUDENT’S NAME: ___________________________ GRADE & SECTION: _______________________
NAME OF PARENT/GUARDIAN: ______________________________________
SCHOOL: __________________________________________________
This is to acknowledge receipt of the Notification Letter regarding the conduct of School –
Based Immunization
YES, I will allow my child to be immunized.
NO, I will not allow my child to be immunized.
Reason/s: ___________________________________________________________
____________________________________________________________
____________________________________________________________
______________________________
Name & Signature of Parent Guardian
DATE: __________________
STUDENT’S NAME: ___________________________ GRADE & SECTION: _______________________
NAME OF PARENT/GUARDIAN: ______________________________________
SCHOOL: _______________________________________
This is to acknowledge receipt of the Notification Letter regarding the conduct of School –
Based Immunization
.
YES, I will allow my child to be immunized.
NO, I will not allow my child to be immunized.
Reason/s: ___________________________________________________________
____________________________________________________________
____________________________________________________________
______________________________
Name & Signature of Parent Guardian