To register your student for Immunization(s), complete the information below.

Immunizations will be provided at the following SCS School Based Clinic:

EAST HIGH SCHOOL
3206 Poplar Avenue
Memphis, TN 38111
Phone: (901) 416-6160

You will need to complete a separate registration for each student.

Question Title

* 1. Select a Date (Immunizations will provided during the hours listed below)

October 5th, 2019 (10:00 am - 2:00 pm)

November 2nd, 2019 10:00 am - 2:00 pm)

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* 2. Student

Last Name

First Name

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* 3. Grade

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* 4. School

Other (please specify)

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* 5. Parent/Guardian

Last Name

First Name

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* 6. Parent/Guardian Email Address

Question Title

* 7. Parent/Guardian Phone Number Format (XXX) XXX-XXXX

Home Phone

Cell Phone

Shelby County Schools offers educational and employment opportunities without regard to race, color, religion, sex, creed, age, disability, national origin, or genetic information. www.scsk12.org