Year 7 Secondary School Vaccine Program

Immunisation Information

Students in Year 7 (or age equivalent) receive two vaccinations on the immunisation schedule:

Human Papillomavirus - 1 dose (Gardasil 9)
Diphtheria, Tetanus, Whooping Cough – 1 booster dose (Boostrix)

Getting your HPV & dTpa vaccinations at school - what to expect

Consent form

Would you like your child to receive their vaccination at school?

Yes

Consent form

Please select your child’s school below, you will be then taken to the Department of Health’s Central Immunisation Records Victoria (CIRV) portal to complete the consent form.

Moe

Morwell

Churchill

Kurnai College Churchill

Traralgon

Privacy statement

The Year 7 Secondary School Vaccine Program is funded by the Australian and Victorian governments and delivered by local councils. Under the Public Health and Wellbeing Act 2008, local councils are responsible for coordinating and providing immunisation services to children being educated within the municipal district.

Local councils are committed to protecting the privacy, confidentiality and security of personal information, in accordance with the Privacy and Data Protection Act 2014 and the Health Records Act 2001.

Local councils report vaccines given through school programs to the Australian Immunisation Register (AIR). Personal identifying details will be kept confidential. These details are for the purpose of providing targeted improved health services for all Victorian children. In addition the details enable tools such as recall and reminder systems to improve vaccination rates. This is important to improve immunisation rates overall. Individuals will have access to their record of all vaccines recorded in the AIR. Aggregate immunisation data may be disclosed to the Victorian government for the purpose of monitoring, funding and improving the Year 7 Secondary School Vaccine Program. This information does not identify any individual.

Information related to you or your child will be used or disclosed for purposes directly related to your child’s immunisation, and in ways that you would reasonably expect. This may include the transfer or exchange of relevant information to your GP, to your child’s GP, to another treating health service or hospital or another local council. The local council may provide you with information related to the school vaccine program via SMS or email. You can access your child’s data by contacting the local council where your child attends school.

The vast majority of people complete and return this form. Thank you for returning yours.

Year 7 Vaccination Program

Student Details

Last name:

First name:

Date of birth (DD/MM/YYYY):

School:

Year Level / Form Group (eg: 7A):

Parent name:

Number beside child's name on medicare card:

Date of Birth

Date of Birth:

School name and campus (if applicable):

Year 7 Secondary School Vaccine Program

Immunisation Information

Consent form

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