Pfizer Vaccine Clinic Sign-Up
A Pfizer Vaccine (2 dose) clinic for individuals 12+ years or older will be held on the campus of the Ralph C. Mahar Regional School, in the gymnasium, on Friday, May 28, 2021 from 2:15 PM - 4:00 PM with the second dose being distributed on Friday, June 18, 2021.
You do NOT have to be a student enrolled at the Ralph C. Mahar Regional School.
Community members 12+ YEARS and older are welcome to attend.
You MUST register for this clinic.
Please complete a form for EACH individual who will be participating in the vaccine clinic.
Please note, all children MUST be accompanied by a parent or guardian.
Consent forms MUST be completed PRIOR to arriving for the vaccine.
VACCINE FACT SHEET:
Last name of the individual receiving the vaccine
First name of the individual receiving the vaccine
Please choose a time slot from for Friday, May 28, 2021; the second vaccine in the series will be Friday, June 18, 2021. Please note, both vaccines will be for the same time selected.
2:30 PM - 2:45 PM
2:45 PM - 3:00 PM
3:00 PM - 3:15 PM
3:15 PM - 3:30 PM
3:30 PM - 3:45 PM
A copy of your responses will be emailed to the address you provided.
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This form was created inside of RC Mahar Regional School District.