COVID Vaccination Interest Survey
Students are NOT required to take the COVID-19 Vaccination. This is only an opportunity for you and your child. Please complete the following survey ONLY if you are interested in you or your child receiving the COVID-19 Vaccination. If you have multiple children, please complete the survey for each child. Qualifying students are those who are over 12 years of age. Also, any Menifee County Resident who has not been vaccinated and is interested in receiving the vaccination, may complete the survey and indicate that you are not a student. This survey is for planning purposes only and does not guarantee access to a vaccine. Additional information will be shared with those interested.
Last Name *
First Name *
Is the person listed above a student? *
Date of Birth *
Phone Number *
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