Covid-19 Vaccination Ages 12-15 Survey

Covid-19 Vaccination Survey

The Health Department will be offering vaccines to children aged 12-15. We are asking for your input!

Question Title

* 1. Would you have your 12-15 year old child(ren) receive the Covid-19 vaccination if made available?

Yes

No

Question Title

* 2. If so, how many in your household (ages 12-15) would participate in the vaccination?

1

2

3

4

5+

N/A