GRAND FORKS PUBLIC HEALTH DEPARTMENT  

151 S 4^th St, Suite N301 , Grand Forks, ND 58201  

Phone: (701) 787-8100, Fax: (701) 787-8145

Dear Parent/Guardian:

The Grand Forks Public Health Department will be holding H1N1 Influenza Clinics at the following school sites:

Students in grades 6 through 12 will have the opportunity to be vaccinated, without parents being present. If you would like your child to be vaccinated, please complete the steps outlined below.  If you have an elementary student, you may bring them to the nearest middle or high school site.

Step 1 Read both Vaccine Information Statements to determine which H1N1 vaccine (mist or shot) you want your child to receive.  Mist is recommended for healthy children ages 2 years old and up, with no chronic health conditions or asthma.

Step 2 Complete page 1 of the H1N1 Influenza Vaccination Record down to and including parent signature and date for consent.

Step 3 Complete all of the screening questions on page 2 of the H1N1 Influenza Vaccination Record.  Be sure to indicate if you want your child to receive the mist or the shot. Elementary parents please return forms to your elementary school office and indicate which site you will attend. 

Step 4 Return completed form (H1N1 Influenza Vaccination Record) to the school office one week prior to clinic date.

Only 6^th - 12^th graders with completed forms will be able to receive the vaccine during school hours without a parent present.  All children in grades K through 5 need to be accompanied by a parent.

H1N1 Vaccine is provided FREE of charge through the Grand Forks Public Health Department. 

If you have any questions, please contact Betty Otteson, RN, at 701-787-8126.