HPV Information Form
Dear Parent or Gaurdian,
A new Indiana Law requires that parents/guardians be informed "about Human Papillamavirus and its vaccine" (IC 20-34-4-5.5).
papillomavirus (HPV) is a virus that young women can contract through
sexual contact. There are many differnet strains of this virus some of
which can later cause cervical cancer. In most instances, a woman will
not know that she has the virus. There is no cure for cervical cancer;
however, there is an immunization available that has significantly
decreased the incidence of developing cervical cancer.
of Indiana IC 20-34-4-5.5 states each parent of a 6th grade female
student shall be required to furnish no later than 20 days after the
first day of school, a written statement stating the current status of
Please respond by checking the appropriate Option
My daughter has received or is receiving the immunization
I have decided not to have my daughter immunized
I have decided not to provide the school with the information concerning this immunization
I have received information concerning human papillomavirus.
I have read and understand the HPV form listed above
When you have completed this form, please select the Submit button below
Wes-Del Community Schools does not discriminate on the basis of race, color, national origin, sex, age, or disability in its hiring or employment practice or in admission to its programs, services, or activities, access to them, treatment of individuals, or in any aspect of their operations.