Polk Schools Student COVID 19 Vaccine Survey
Please complete this survey ONLY if you are interested in your child receiving a Pfizer COVID 19 vaccine at one of our schools. This survey is anonymous and will be used for planning purposes only. Parent permission is required for any child to receive a vaccine.
How many children (12 years of age or older) would you like to receive the COVID 19 vaccine?
5 or more
Where would you like for your child to receive the vaccine?
Polk County High School
Polk County Early College
Polk County Middle School
The elementary school in my community
Some other location not at a school
Please submit any questions you have about the vaccine or the school vaccine events we are planning.
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This form was created inside of Polk County Schools.