Children's Flu Consent Form

A legally recognised guardian must accompany the child attending. For instance:

  • Biological Parents
  • Adopted Parents
  • Foster Parents

If you are not attending with your child for their flu vaccine, please provide consent for us to vaccinate them in your absence. 

To provide this consent, please do so via the form below:

 

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Personal Details
Medical Information

If your child has become wheezy, had an asthma attack, or had to increase their reliever inhaler in the 3 days before the vaccination is scheduled, please let the immunisation team know, either before or on the day of the vaccination.

Confirmation

Privacy Consent

This form collects personal and medical information about you. We use this information to allow the practice team to contact you. Please read our Privacy Policy to discover how we protect and manage your submitted data.

 
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Last Reviewed: 02/09/2026