Thank you for choosing Berrien County Health Department to provide your child’s influenza vaccination.

Berrien County Health Department will be offering both printed and online consent forms this year. Printed paper forms will be distributed by your child’s school and can be accessed below. Electronic consent forms can also be accessed at the link below.

Forms should be completed and returned to your child’s school no later than September 3, 2025.

Click below to view the Berrien County HIPAA Privacy Notice as well as South Health District’s HIPAA Privacy Notice (available in English and Spanish) and the Center’s for Disease Control and Prevention’s Influenza Vaccination Statement.

Parent Letter (English)
Parent Letter (Carta a las padres)
Consent Form English
Consent Form Spanish (Formulario de consentimiento)
Electronic Consent Forms/Formulario de consentimiento electrónico
HIPAA Privacy Notice (English and Spanish)
CDC Vaccine Statement