Minnetonka Public Schools COVID-19 Vaccination Clinic (open to all students age 12 and over)
In collaboration with Community Care Clinics of Minnesota, Minnetonka Public Schools will be hosting a COVID-19 vaccine clinic at MMW and MME on Monday, June 7th. This clinic is open to Minnetonka students aged 12 and over. The clinic is for both first and second doses. If you received your first dose at the May 17th Minnetonka clinic, you are already registered and do not need to complete this form. If you are receiving the first dose with Minnetonka on June 7th, please complete this online registration.

A printed consent form with a parent or guardian signature will be required for all students under 18 to receive a vaccine, be that first or second dose. The link to that form (pdf) is: https://drive.google.com/file/d/1gZyDW3CAczAtOSqRqB7qEACWNcUGyIYx/view?usp=sharing

To begin the registration, please add your parent/guardian email address below
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Email *
1) Parent or guardian name *
(Last, First)
2) Parent or guardian phone *
(123) 456-7890
3) Student name *
(Last, First)
4) Student school ID number
i.e. 004321
5) Student age *
(Students must be 12 years old or older as of 5/17/2021)
6) I certify that my student will be 12 years of age or older as of 06/07/21. *
(Students must be 12 years old or older as of 06/07/2021)
Required
7) Student birthday *
MM
/
DD
/
YYYY
Please choose ONE option for your student to receive the vaccine.  
Note: you are not signing up for a specific time.

*MMW anytime from 8:30 AM to 9:15 AM

*MMW anytime from 9:15 AM to 11:30 AM (students will be escorted to/from class to the vaccine clinic)

*MME anytime from 12:30 PM to 3:55 PM (students will be escorted to/from class to the vaccine clinic)

*MME anytime from 3:55 PM - 5:30PM

NOTE: we will not be allowing parents/guardians into the building during the school day, so your child will need to go in and receive the vaccination on their own if you have signed them up for that time slot.  If they are attending school in-person, then they will be escorted to/from class to the vaccine clinic.  Once they have been observed post-vaccination for the required amount of time, they will be brought back to class or will be sent out to go home with their parent/guardian.  It is important to note that there will be increased congestion at the beginning and end of the school day due to buses and parent pick up/drop off, so please plan accordingly.
8) Choose the school and time slot that is most appropriate for your child. PLEASE NOTE that the option you chose for the clinic on May 17th will be the SAME option you are assigned for the 2nd dose on June 7th. *
A parent or guardian signature will be required for all students under 18 to receive a vaccine.
A copy of your responses will be emailed to the address you provided.
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