Crawford Village: Vaccine Registration Form
Bethany Community Ministries is hosting a COVID-19 Vaccination Event at Crawford Village in partnership with Cash for Kids, Highmark Wholecare, Allegheny Health Network, and PCHS. Please complete this form to pre-register for the event. Children under 18 must be accompanied by an adult to receive the vaccine.

Event Date: Thursday, March 3, 2022
Location: Crawford Village
2901 Brownlee Ave, McKeesport, PA 15132
Time: 4:00 PM to 8:00 PM
Eligibility: Ages 5+
Cost: FREE

Vaccines Available:
- Pfizer (2-step): Ages 5 & up
- Moderna (2-step): Ages 18 & up
- Johnson & Johnson (1-step): Ages 18+

Cash Incentive:
- $50 for 1st dose of the vaccine
- $25 for 2nd OR booster dose
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First Name *
Last Name *
Phone Number *
Phone Type *
Email Address *
Zip Code *
Date of Birth *
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Race *
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Ethnicity *
Gender *
Which vaccine do you want to receive? *
Which dose will you be receiving? *
Who is your insurance provider? *
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