Please complete only one questionnaire for each person

The Cumberland County Immunization nurses will return to Chebeague Monday, December 6 at the Island Commons and Chebeague Recreation Center. They will offer Covid vaccines to anyone age 5 and older for initial vaccination. Ages 5-12 will get a pediatric dose. Any one can get a booster dose if they want one, though in general, booster vaccines are recommended for people over 65, people with an underlying condition that weakens their immune system, or persons who live or work in conditions that are higher risk. Since we are needing to be in close quarters as islanders traveling to the mainland by boat, we want to have maximum immunity. So if you want a booster, and its been 6 months since your last vaccine, you can just sign up.

Please sign up as soon as possible to ensure an adequate supply of the vaccine!

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* 1. Please provide information for the person to be vaccinated.

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* 2. Provide name of legal guardian if they are under age of 18.

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* 3. Date of Birth of person to be vaccinated

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* 4. Address on Chebeague Island

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* 5. Preferred telephone number (landline or cell -- (xxx) xxx-xxxx)

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* 6. Please indicate if you have been vaccinated and, if so, with which vaccine

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* 7. If vaccinated, please indicate the date of your last shot

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Please sign up as soon as possible to ensure an adequate supply of the vaccine!  You will be contacted to make an appointment.  Please being your vaccine card to the Island Commons or the Chebeague Recreation Center at your appointment with the public health nurse.  If you have questions, call or text Jenny Hackel, NP at 734-660-3461.

And after you receive your shot, you may wish to visit the CDC V-Safe program and download the app for post -vaccination surveillance.

Thank you very much for your responses to this survey. Please remember to wear your mask, practice social distancing, and wash your hands frequently.  Stay safe!

Town of Chebeague Island
Justin L. Poirier, Town Administrator
207-846-3184
townadmin@townofchebeagueisland.org

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