DOWNLOAD: Vaccine consent form

Meningococcal vaccine program

In 2017 the Victorian Secondary School Vaccine Program will offer free meningococcal ACWY vaccine to students in Years 10, 11 and 12. The vaccine that protects against four strains of meningococcal disease—A C W Y—is administered as a single dose.

Local councils will deliver the vaccine program but BSSC is responsible for distributing information and consent cards to parents/carers of students.

What do I need to do?

  1. Your information will be provided to City of Greater Bendigo in August 2017. If you do not wish for your details to be provided, please advise the college via before Tuesday 8 August 2017.
  2. Read the information provided on the consent form (attached) and complete all sections, regardless of whether or not you consent for your child to be vaccinated as part of the school-based program.
  3. Detach/print the consent form, fully completed, and the time selection sheet (see below). Return both to BSSC General Office no later than Friday 4th August.  Please note that students aged 18 years or older are able to sign their own consent form.
  4. The consent form must be returned, even if you do NOT wish your son or daughter to be vaccinated. Hard copies of all documentation is available at the General Office.


BSSC school-based immunisation program

Students will have the opportunity to be vaccinated on the following dates and times:

  • Tuesday 8 August from 9am – 3.30pm
  • Thursday 10 August from 9am – 3.30pm

Students must attend in their study periods or Study Centre session or from 1.10pm – 3.30pm on either day if they do not have a scheduled class or SAC.  The vaccinations will be given in the Staff Centre (next door to the Wellbeing Centre; opposite the Student Services Centre).  All students will be required to remain for 15 minutes observation after receiving the vaccination.

For further information please go to the following links:


Alternatively, you can contact:

Viv Harris (Youth Health Nurse – Mondays and Tuesdays only) on 4408 6269 or

Kylie Hand on 4408 6168.

Please indicate the session you are going to attend by ticking the appropriate box below and return this slip with your consent form to the BSSC General Office by Friday 4 August.

Name: _______________________________ 

Advisor group: _________________________ 

Mobile:  ______________________________


Tuesday 8 August Thursday 10 August
9.00 – 10.00am 9.00 – 10.00am
10.00 – 11.00am 10.00 – 11.00am
11.00 – 12.00pm 11.00 – 12.00pm
12.00 – 1.00pm 12.00 – 1.00pm
1.00 – 2.00pm 1.00 – 2.00pm
2.00 – 3.00pm 2.00 – 3.00pm


Some more Information

The Public Health and Wellbeing Regulations 2009 authorises secondary schools to provide their local council with student and parent/guardian contact information for any student scheduled to receive a vaccination.

What information goes to local council?

Schools provide the following basic student and parent/carer contact information:

  • Student name, gender, date of birth, year level, class, language(s) spoken at home.
  • Parent/carer names, phone numbers, email and postal addresses.


Why do schools provide this information?

  • To ensure all students have the opportunity to access free meningococcal ACWY vaccination at school.
  • To improve communication with parents/carers regarding their child’s vaccination needs.