Flu Clinic - Clayton
Where: Clayton Middle School
When: Thursday, November 12, 2026
Time: 12:00 pm – 3:00 pm Who: Students, Siblings, and Parents (see attached permission forms and instructions)
What To Do: Fill out one of the permissions forms and return to the office by: November 9, 2025
Choose the appropriate attached permission form described below. Parents need to complete only one of the permission forms. Please choose the form that applies to your student.
Complete the Health Department Vaccine Encounter Form (Permission Form) if your student is covered by any of the insurance companies listed: Select Health, Cigna, EMI Health, United Health PEHP, Aetna. We are unable to give shots for any other insurance company.
- Fill out all the student information (the top half) on the front of the page. On the other side, initial all boxes, and complete parent/guardian information and sign.
- Make a copy of the front and back sides of the insurance card.
- Send or bring the form and the copy of insurance card to school by the due date: Monday, November 9, 2024.
Complete the VFC (Vaccine for Children’s) Vaccine Permission Form if any of the following apply to your student: Uninsured, Medicaid, CHIP, Native or Alaskan American. This form can only be used for students 18 years of age and younger.
- Fill out all the student information at the top of the page and check the option that applies to your student, then sign on the Parent/Guardian line. We do not need a copy of the Medicaid or CHIP card.
- Send or bring the form to the front office of the school by the due date.
- For questions, please call Kristi Runyan at 801-481-4810 x1010