MADISON PARISH SCHOOL DISTRICT COVID-19 VACCINE ADMINISTRATION SURVEY

Question Title

* 1. Are you interested in your child/children taking the COVID-19 vaccine?

Yes

No

Question Title

* 2. If you answered "yes" to the question above, how many children do you have 12 and older in school?

1

2

3

4

5

Other (please specify)

Question Title

* 3. Which school(s) does/do your child/children attend?

Wright Elementary

Madison Middle

Madison High