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Birmingham City Schools began earlier this year making COVID-19 vaccinations available in our schools for students ages 12 and up, their families and community residents. Our partners including Alabama Regional Medical Services, MedsPLUS Consulting, Cahaba Medical Centers, and the Jefferson County Department of Health, have provided the Pfizer COVID-19 vaccine (mRNA vaccine). This vaccine has received emergency use authorization by the FDA and is available for children ages 5 through 11. 

Please complete one survey for each of your children currently enrolled in Birmingham City Schools. This will help us better understand parent preferences around vaccinating child(ren) and interest in vaccinating child(ren) at their school. This survey is meant to inform interest only.

This is an anonymous survey. We are not requesting any personal identifiable information. Your responses will assist us as we continue our efforts to provide a safe and healthy environment in Birmingham City Schools. Please complete the survey by noon on Monday, November 15, 2021,

Thank you.

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* 1. Please select the school that your child attends (Complete one separate survey for each of your children enrolled in grades K-12 in Birmingham City Schools.)

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* 2. My Child is in _________ Grade. (Check One)

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* 3. Of all the adults (18+ years old) living in your household, how many have received at least one dose of a COVID-19 vaccine? *

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* 4. How many children in your household are between the ages of 12 and 17?

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* 5. How many of your children between the ages of 12 and 17 have been vaccinated for COVID-19?

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* 6. If none of your children between the ages of 12 and 17 have been vaccinated, please share your concerns.

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* 7. How many children do you have living in your household ages 5 through 11? 

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* 8. How many people in your child’s immediate family have had COVID-19?

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* 9. If offered, would you consider getting your child between the ages of 5 and 11 vaccinated at school? 

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* 10. Parents or a consenting adult must accompany minors who are getting vaccinated. Tell us what time of day works best for you and your family.

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* 11. If you are not interested, what are your concerns?

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