Vaccines 12-15 year olds

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

On Saturday, May 15, 2021 Students who are 12-15 years or older are invited to the Watertown Public Schools Closed Vaccine Clinic located at 61 Echo Lake Road, Watertown, CT. Students under the age of 18 require an accompanying adult on the day of the vaccine.

If you would like to take part in the WHS closed clinic, please complete the form below AND register on VAMS by visiting https://portal.ct.gov/vaccine-portal/COVID-19-Vaccination-Phases.

Email *

Last Name *

First Name *

Date of Birth *

YYYY

Email Address used to register on VAMS (this should not be the same address a parent used when receiving their own vaccine) *

Home Address (Include City, Zip Code) *

Phone Number *

Send me a copy of my responses.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This form was created inside of Watertown Public Schools. Report Abuse

Forms