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HPV Vaccination Consent for Grade 4 Students

This notification letter informs parents that the Departments of Health and Education will conduct a free human papillomavirus (HPV) vaccination program for female grade 4 students aged 9-13. HPV is responsible for most cervical cancer cases. The vaccination will help protect adolescents before they are exposed to HPV. Parents must provide consent for their child to receive two doses of the HPV vaccine in August 2017 and February 2018 by checking "Yes" or "No" and signing the attached acknowledgement form.

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Rej Nicdao
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160 views1 page

HPV Vaccination Consent for Grade 4 Students

This notification letter informs parents that the Departments of Health and Education will conduct a free human papillomavirus (HPV) vaccination program for female grade 4 students aged 9-13. HPV is responsible for most cervical cancer cases. The vaccination will help protect adolescents before they are exposed to HPV. Parents must provide consent for their child to receive two doses of the HPV vaccine in August 2017 and February 2018 by checking "Yes" or "No" and signing the attached acknowledgement form.

Uploaded by

Rej Nicdao
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd

Republic of the Philippines

DEPARTMENT OF EDUCATION
AND
DEPARTMENT OF HEALTH
REGION III
Province/City of_________

================================================================================================
NOTIFICATION LETTER

DIVISION: ____________________________________________
SCHOOL: ____________________________________________
ADDRESS: ____________________________________________
DATE: ____________________________________________
STUDENT’ NAME: ____________________________________________
STUDENT’S ADDRESS: ____________________________________________
NAME OF PARENT/GUARDIAN: ____________________________________________

Dear Mr. And Mrs.: ____________________________________________

The Department of Health through the Regional Office III and Provincial/City Health Office of _______________
in collaboration with the Department of Education, shall conduct free Human Papillomavirus (HPV) vaccination
among public Grade 4 female learners (within the age range 9-13 years old) on August 2017 (first dose) and on
February 2018 (second dose).

Human Papillomavirus (HPV) is responsible for the vast majority of cases of cercial cancer. Most sexually
active women and men are infected with HPV at some point in their lives, with maximum risk of exposure in young
adults between 15 and 24 years of age.

Adolescent age group makes up a significant proportion of each country’s population. In the Philippines,
they comprise about 21.5 percent of almost 20 million of the 92 Filipinos in the 2010 census (NSO, 2010) as cited by
the University of the Philippines Population Institute. They are teh major contributors to the labor force and thus
form the backbone of each country’s economy.

Maximum benefit from HPV vaccination may be obtained in adolescents because they have not yet been
exposed to HPV and they mount the highest immune response to vaccination.

This Notification is being issued to you as information of the activity that will be conducted on August 2017
and February 2018. Should you have further questionss/clarficationos on this matter, please get in touch with the
Principal/School Head.

Thank you.
Very truly yours,

________________________________________
(Name of Principal/School Head

ACKNOWEDGEMENT AND CONSENT


This is to acknowledge receipt of the Notification Letter regarding the conduct of School-Based HPV
vaccination activity.

I have read and understood the information regarding Human Papillomavirus (HPV) Vaccination
among Adolescents including contraindications such as pregnancy.

(Please check the box provided)

Yes, I allow my child to be vaccinated with 2 doses of HPV


No, I don’t allow my child to be vaccinated with 2 doses of HPV

Reason (Please specify): ________________________________________________

__________________________________________________________________________
Name and Signature of Parent/Guardian

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