XLIS Students Flu Vaccination Receipt 2023

Students Full Name *

Passport Number *

Select Grade *ClassPrimary SchoolSecondary School

Primary SchoolECEAECEB1ECEB2PYP 1APYP 1BPYP 2APYP 2BPYP 2CPYP 3APYP 3BPYP 3CPYP 4APYP 4BPYP 4CPYP 5APYP 5BPYP 5CPYP 6APYP 6BPYP 6C

Secondary SchoolMYP 1AMYP 1BMYP 1CMYP 1DMYP 2AMYP 2BMYP 2CMYP 3AMYP 3BMYP 4AMYP 4BMYP 5AMYP 5BDP 1ADP 1BDP 2

Vaccination Date *

Vaccination Site *

Please submit the vaccination receipt. *

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