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Information for those students interested in receiving the Pfizer vaccination.
*
1.
If my child's/children's school would host a vaccination clinic, I would be interested in my child(ren) receiving a vaccination. (Must be 16 years of age or older.)
(Required.)
Yes
No
I'm unsure at this time.
*
2.
Name(s) of above student(s), age 16 or older, who may be interested in getting the COVID vaccination.
(Required.)
3.
Name(s) of Parent(s) or Guardians of student(s) who will be getting vaccinated?
*
4.
The name of the school in which the student(s) is attending?
(Required.)
5.
Parent Phone Number
6.
Parent email address. (We will email more information to this address. If no email is provided, we will call the number provided to provide other options.)
Current Progress,
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