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

Clinic Date: December 17, 2021 3 pm - 7 pm

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

https://www.cdc.gov/coronavirus/2019-ncov/vaccines/keythingstoknow.html

https://www.tayohelp.com/hc/en-us


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Email *
Name  (ex. JP Jael) *
Phone Number (ex. 773-555-5555) *
Age *
Preferred vaccine (ages 12+ only) *
Preferred appointment times (15 minute appointments) *
Required
Preferred language *
Required
A copy of your responses will be emailed to the address you provided.
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