Mobile COVID-19 Vaccination Clinic

Chilton ISD Community Survey

The Chilton ISD, in conjunction with the Texas Military Department and the Texas Division of Emergency Management, will host a COVID-19 Mobile Vaccine Clinic. The vaccination clinic will provide COVID-19 vaccinations for participants ages 12 and up at no cost. This survey is intended to gather data in order to better coordinate and support this community clinic.

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* 1. As a member of the Chilton ISD community, and surrounding areas, are you interested in receiving a COVID-19 vaccination at no cost to you?

Yes, I am interested.

No, I am not interested.

I have already received a COVID-19 vaccination.

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* 2. If interested, how many family members will participate with you?

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* 3. Will family members between the age of 12 and 17 receive a vaccination? If so, please ensure that a parent/guardian is available to provide signed approval.

Yes