Vaccine Clinic Parent Interest Survey
Alabama Department of Public Health is collaborating with Jacksonville City Schools to offer all students 12 years old and older the opportunity to receive the Pfizer vaccine before the start of the 2021-2022 school year. This survey is to determine the interest in a vaccine clinic hosted at one of our schools.
Under current rules, students and adults who are fully vaccinated will not have to quarantine even if exposed to a positive case. Please take time to read the vaccine information and guidelines linked to the JCS website
. After reading the information, please let us know if you or your children would like to get vaccinated.
The date, time, and place of the vaccination clinic will be announced at a later date.
I would like for my 12 year old or older child to get the Pfizer COVID-19 vaccine.
If you answered yes, please indicate how many children.
Please list the age(s) of your child (children).
I and/or another adult in my family would like to get the Pfizer COVID-19 vaccine.
If you answered yes, please indicate how many adults.
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This form was created inside of Jacksonville City Schools.