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* 1. Do you plan to have your child/children get a COVID-19 vaccine as soon as it is approved for their age group?

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* 2. If you are not sure, do you think you will have them get the vaccine a few months after it is approved for their age group? (If you are going to get the vaccine as soon as it becomes available to you, please skip to Q5.)

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* 3. If you are not sure or will not have your child/children get the COVID-19 vaccine as soon as it become available to you, why not? Please check all that apply.

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* 4. If you are not sure or will not have your child/children get the COVID-19 vaccine as soon as it become available to you, what might make you decide to get the vaccine at a later time?

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* 5. We do not yet know which vaccines will be approved for younger age groups. If approved for your child’s age group, which vaccine(s) would you be comfortable giving to your child? Please check all that apply.

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* 6. Where would you be comfortable having your child/children receive the COVID-19 vaccine when you choose to do so? Check all that apply.

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* 7. Please add any questions, comments, or suggestions for vaccination information and distribution of the COVID-19 vaccine in Carroll County. We appreciate your input!

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* 8. What ages are your children? Check all that apply.

  0-5 6-11 12-15 16+
Child 1
Child 2
Child 3
Child 4
Child 5
Child 6
Child 7

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* 9. How many children 12 and up do you plan to vaccinate?

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* 10. Where do your children attend school? Check all that apply.

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* 11. Do you live in Carroll County, Maryland?

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* 12. What is your ethnicity?

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* 13. What is your race? Please check all that apply.

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* 14. What is your gender?

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* 15. What is your age?

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