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)
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
Name (ex. JP Jael)
Phone Number (ex. 773-555-5555)
Pfizer (12+ years only, two shots required, 2nd shot administered July 18, 2021)
Jonson and Johnson (18+ years only, only one shot required)
Preferred range of time (15 minute appointments)
11 am - 12 pm
12 pm - 1 pm
1 pm - 2 pm
2 pm - 3 pm
3 pm - 4 pm
A copy of your responses will be emailed to the address you provided.
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This form was created inside of Filipino Young Leaders Program.