WJCS Center Lane and The LOFT present: Westchester Pride Vaccination Days!
It's important for us to be able to reach you to schedule and follow up with your vaccine. Your information will be kept confidential and seen only by WJCS Center Lane or The LOFT staff to confirm vaccine eligibility and track who we have served. Please answer all questions honestly.
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I would like to get vaccinated
1st dose on Saturday, June 26th, 2nd dose on Saturday, July 17th, 10am - 2pm: The LOFT LGBTQ+ Community Center, 252 Bryant Ave, White Plains
What is your first name (the one you would like us to use)?
What is your last name?
What is your date of birth?
Which pronouns do you use?
Another / Not listed
If you use more pronouns, or you selected 'Another / Not listed' above, what pronouns do you use?
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This form was created inside of Westchester Jewish Community Services.