Age 5-11 COVID-19 Vaccination Interest Form
In anticipation of final FDA approval of the COVID-19 vaccine for children ages 5-11, the Ken-Ton School District is making preparations to hold vaccination clinics in school buildings through various partnerships.

For planning purposes, we will need to know approximately how many children would participate. Please use this form to indicate how many students in your household ages 5-11 would potentially sign up to receive the COVID-19 vaccine should such an opportunity be made available. The plan will include parents and guardians being present at any such clinic.

Please keep in mind that this form is not a registration as we are attempting to plan these clinics for those that are interested. This is not and will not be mandated in Ken-Ton at this time. It is merely a potential option for families. Details regarding specific vaccination clinic options and instructions on how to sign up will be shared with families in the near future.

Email web_help@ktufsd.org if you encounter any issues or are unable to complete this form.
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Which school(s) do your children attend? (Choose all that apply) *
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How many students in your household ages 5-11 would you wish to have vaccinated? *
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