新竹市建功國小115年度流感疫苗注射同意書線上填寫說明

各位家長~

本校今年將於115年10月2日(五)上午由城佑耳鼻喉科診所到校進行全校流感疫苗接種，請每位家長務必於9/20(日)前上網填寫並勾選意願調查表。

1.若同意學生在校施打，請勾選同意並簽名，將於10/2統一在校施打。

2.若不同意學生在校施打，請勾選不同意並簽名即可。

3.若仍在猶豫不確定者，請先勾選同意並簽名，以利準備疫苗數量。

4.疫苗的廠牌須等到施打前一天或當天才知道，若有接獲通知，會盡速公告。

流感接種同意書線上填寫方式及流感疫苗說明，請參閱『115年度-建功國小流感接種意願書線上填寫說明』。

※線上簽署同意書網站連結:

https://nias-school-survey.cdc.gov.tw/survey/000000000000B2A6e203?openExternalBrowser=1

建功國小健康中心 敬啟

Instructions for Completing the Online 2026 Influenza Vaccination Consent Form

Dear Parents and Guardians,

Our school will be holding the 2026 School Influenza Vaccination Program on Oct. 2, 2026 (Fri.), in the morning. Medical staff from Cheng-You ENT Clinic will come to our school to administer influenza vaccines to students.

All parents and guardians are kindly requested to complete the online vaccination consent form and indicate your decision by Sunday, September 20.

1. If you agree to have your child vaccinated at school, please select “Agree” and sign the online consent form. Your child will receive the influenza vaccine at school on October 2.

2. If you do not agree to have your child vaccinated at school, please select “Disagree” and sign the online consent form.

3. If you are still undecided, please select “Agree” and sign the consent form for the time being. This will help us estimate and prepare an adequate number of vaccine doses.

4. The brand of influenza vaccine will not be confirmed until the day before or the day of vaccination. If we receive information regarding the vaccine brand in advance, we will announce it as soon as possible.

For instructions on completing the online influenza vaccination consent form and for more information about the influenza vaccine, please refer to “2026 Jiangong Primary School – Instructions for Completing the Online Influenza Vaccination Consent Form.”

Online Vaccination Consent Form:
https://nias-school-survey.cdc.gov.tw/survey/000000000000B2A6e203?openExternalBrowser=1

Sincerely,
Health Center
Jiangong Primary School