Health Services at Viking
Flu Immunization Clinic
The St. Croix County Public Health Department will be providing a free influenza
immunization clinic for school-aged children on Thursday, October 16th. If you would
like your child to receive the injectable influenza vaccine, a parent or legal guardian
must fill out a consent form, unless the student is 18 years of age. The parent does not
need to be present at the clinic if the child brings a signed consent form. Please return
the signed and dated consent form to school no later than Monday, October 13th.
The consent form and vaccine information sheet can be found below, on the school
website, or at the school offices.
Thursday, October 16th
8:30 am Greenfield Elementary School
10:30 am Baldwin-Woodville High School
1:00 pm Viking Middle School
Consent form English
Consent form Spanish
Vaccine information statement English
Vaccine information statement Spanish
Health Services Forms
BWSD Epinephrine Medication Form - EPI Pens (Dr. Signature Required)
BWSD Glucagon Medication Form - Glucagon Injectable (Dr. Signature Required)
BWSD Inhaled Medication Form - Inhalers and Nebs (Dr. Signature Required)
BWSD Prescription Medication Form - Prescription Medications (Dr. Signature Required)
BWSD Doctors Order Form - Generic order's (Dr. Signature Required)
BWSD OTC Medication Form - Over the Counter Medications
Student Immunization Record - Student Immunization Record/ Waiver form from the State of Wisconsin. Forms are in English, Hmong, Somali, and Spanish.
