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Parent Consent for Health Screening
Trinity Health System
Employee Health Services
Parent/Guardian Consent for Health
Screening of a Minor
All volunteers are required to have a health screen by Employee Health Services. This includes the following:

• Proof of a Tetanus, Diphtheria, Pertussis (Tdap) within 10 years
• Tuberculosis skin test. Two tests 1-2 weeks apart
• Immunization History
• Flu vaccine annually or proof of vaccination during current flu season NOT needed for Summer Teen Program

Consent:
I authorize Employee Health Services to perform the above health screening for: