HPV Immunisation Consent Form

YES, I consent for my child to receive the HPV immunisation
Please contact the immunisation team on 0333 358 3397

Please do not take your child to your Doctor to have this vaccine if you are giving consent for them to have it in school.

Childs Details
  • Male
  • Female
Coal Clough High School
Parent/guardian Details
  • Yes
  • No
  • Phone
  • Email
Important information about this immunisation
  • Yes*
  • No
  • Yes*
  • No
  • Yes*
  • No
Informed Consent
Your Acceptance
This website is using cookies. Privacy Statement. That's Fine