Vaccination Appointment Form
DATES: Friday May 14 & Friday June 11
TIME: By appointment, 9:40 AM–2:50 PM
WHERE: UW Tacoma Campus, 1900 Commerce Street, Tacoma WA 98402

We'll do our best to reserve your preferred appointment time (between 9:40 AM and 2:50 PM). After we receive your form, we'll email or text you a confirmation with your exact time slot. We'll be in touch closer to the event with exact entrance and parking information.

Your appointment time on May 14 will automatically be the same on June 11. If you need a different time on June 11, please make the request when you arrive for your first appointment.

Vaccinations are available for those age 19 and older. If you are age 16-18, Oasis Youth Center will be providing Phizer vaccinations on Wednesday May 14. For more information, provide your contact information using this form, and note in the last box that you're interested in the Oasis event.

If you have questions about this form, or registering for an appointment, email Ken at ken@rainbowcntr.org.
Full name: *
Name I like to be called:
Phone:
Can we send texts to phone number above?
Email:
Birthdate: (Ages 19 and older; see note above.) *
MM
/
DD
/
YYYY
Preferred appointment time on both days (May 14 and June 11) between 9:40 AM – 2:50 PM: *
Time
:
Please let us know of any language or accessibility needs for your visit.
Any other notes or questions?
Submit
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