LF Vaccine Clinic Interest Survey
Please fill out the following form if you are interested in receiving the COVID vaccine and/or the flu vaccine. LF would like to host a clinic on Wednesday, 10/6/21. Please note that the COVID vaccine would be an initial vaccine, and not the booster. Please consider this opportunity to help keep the Little Flower community safe and fully operational during the 2021-22 school year.
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First Name *
Last Name *
Date of Birth *
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DD
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YYYY
Street Address *
City *
State *
Zip Code
Best Phone Number *
Best Email *
Are you interested in receiving an initial COVID Vaccine? *
Are you interested in receiving a Booster COVID vaccine (Pfizer only if after 6 months) *
Are you interested in receiving a flu vaccine? *
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