COVID-19 Vaccination Survey
Currently, the Pfizer-BioNTech COVID-19 Vaccine is authorized for use in individuals 16 years of age and older. The Essex County Health Department expects that the authorization for use will soon expand to include children 12 years old and older. In anticipation of this change, we would like to gauge the current level of demand for Pfizer-BioNTech COVID-19 Vaccine in these age groups. Please complete this survey ONLY if you would grant permission for your child to receive COVID-19 vaccination (in the presence of their parent/guardian) at their school. Please complete only one survey per household.
How many students 16 years old or older live in your household AND would like to receive the COVID-19 Vaccine at a school vaccine clinic? *
How many students 12 - 15 years of age live in your household AND would like to receive the COVID-19 Vaccine? *
Please select the School District your child(ren) attend(s). Choose ONLY ONE option.
If your children attend different school districts, please list the additional districts below. Include the number of children aged 12 and above that attend each of the additional districts listed.
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