Phone: (989) 632-3390
Fax: (989) 632-3393
1350 N. St. Helen Rd
Saint Helen MI, 48656
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I authorize Charlton Heston Academy to release my student's immunization record to the Michigan Department of Health and Human Services and Local Health Department. I understand this information will be used to improve the quality and timeliness of immunization services and to help schools comply with Michigan Law. This includes any immunization information and limited personally identifiable information from the school.
Immunizations are an important part of keeping our students healthy. Schools and State and Local health departments must monitor immunization levels to ensure that all communities are protected from potentially life-threatening diseases and, if necessary, respond promptly to an emerging public health threat. It is important that disease threats be minimized through the monitoring of students being immunized. Sharing immunization and personally identifiable information including the student’s name, Date of Birth, gender, and address with local and state health departments will help to keep your student safe from vaccine preventable diseases. The Family Educational Rights and Privacy Act (FERPA), 20 U.S.C. § 1232g, requires written parental consent before personally identifiable information from your student's education records is disclosed to the health department. If your student is 18 or over, they are an “eligible student” and must provide consent for disclosure of information from his or her education records. You may withdraw your consent to share this information in writing at any time.
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