August 18th Vaccine Clinic

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Goochland County Public Schools is partnering with the Virginia Department of Health to provide a vaccine clinic to our students. At this clinic, students will be able to receive the Diphtheria, Tetanus, & Pertussis (Tdap) booster and Meningococcal vaccine (1st or 2nd dose). (Tdap and one dose of Meningococcal vaccines are required for rising 7th graders; at least one Meningococcal vaccine after the age of 16 is required for rising 12th graders).

Additionally we will have the Pfizer Covid-19 vaccines available for students (ages 12 and up) and families who are interested in receiving that vaccine as well. Parents do not need to be present while their children are being vaccinated, however, they will need to have a trusted adult present and a parent or guardian will need to sign consent for the vaccination(s) to occur. All vaccines are free.

Student's First and Last Name (Please complete a separate form for each student who qualifies) *

Parent/Guardian's First and Last Name *

Parent/Guardian's Phone Number *

Student's Phone Number (if applicable)

I am interested in my child receiving the Tdap booster vaccine. (Rising seventh graders must have this vaccine prior to beginning school on 8/23/21.) Students will not be able to attend school until proof of vaccine is received. *

Yes

I am interested in my child receiving the Meningococcal Conjugate (MenACWY) vaccine. (Rising seventh graders must have their first dose prior to beginning school on 8/23/21. Rising twelfth graders must have at least one dose after age 16 prior to beginning school on 8/23/21.) Students will not be able to attend school until proof of vaccine is received.

Yes

Clear selection

I am interested in my child receiving the Pfizer COVID-19 vaccine. *

Yes

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