Posted: Wed, 03/14/2012 - 2:21pm Updated: Tue, 06/25/2019 - 8:54am

CHIRP Permission form

To utilize the Children and Hoosiers Immunization Registry Program (CHIRP), active parent permission is required for school nurses to submit immunization records into the registry to comply with the Family Educational Rights and Privacy Act (FERPA). Dana Long, an attorney at the department, has prepared this form for schools to use to obtain parent permission. A signature from a parent is only required one time. The immunization record is moved forward to the next grade level every August within the CHIRP system. For more information about CHIRP, go to at the Indiana State Department of Health.