St. Padre Pio Parish/St. Hilary's COVID-19 Vaccine Clinic
Patient Registration Form. Once registered, a volunteer will call or email with your confirmed appointment time.

Clinic Dates: June 27 1st dose (Pfizer or J&J), July 18 2nd Dose (Pfizer)

Church Rectory
St. Padre Pio Parish at St. Hilary’s
5600 N Fairfield Ave, Chicago, IL 60659

Questions? Ask JP Jael (708-717-8283) or Iam Calsita (773)-561-3474

For more information about COVID-19 vaccines, please visit the websites below

Email *
Name (ex. JP Jael) *
Phone Number (ex. 773-555-5555) *
Age *
Preferred vaccine *
Preferred range of time (15 minute appointments) *
Preferred language *
A copy of your responses will be emailed to the address you provided.
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