COVID-19 Vaccinations

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COVID-19 Vaccinations

Complete the registration form for the COVID-19 Vaccination on June 16th at East Bernstadt School (provided by the Laurel County Health Department's mobile unit). It will be walk in from 9:00-12:00. ***Complete Parent/Guardian portion for students. Type N/A if person receiving the vaccination is 18 or older.***

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* Indicates required question

First Name (Person being vaccinated) *

Your answer

Last Name (Person being vaccinated) *

Your answer

Parent/Guardian's First Name *

Your answer

Parent/Guardian's Last Name *

Your answer

Submit

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