CTU Center Vaccination RSVP Form
Please RSVP by completing this form once for EACH child or adult being vaccinated. Vaccinations will be offered for educators, students, parents, and community members ages 5 and up. Registration encouraged, but all walk-ins accepted. No one turned away! Anyone under 18 years old MUST have a parent or guardian present at the vaccination to sign providing consent. VACCINES ARE FREE! - No Insurance required. ID required. If you are getting a second or booster shot, please don’t forget the card from your previous vaccination.

DATE: Friday, December 3, 2021

TIME: 3:00 pm - 7:00 pm

LOCATION: CTU Center

ADDRESS: 1901 W. Carroll Ave

VACCINE: Pfizer (Approved for ages 5 and up)
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Are you registering for yourself or on behalf of a family member? *
Registrant's First and Last Name *
Registrant's Email Address
Age of the Registrant *
Which shot is this in the registrant’s series? *
If you are completing this form on behalf of someone else, please provide YOUR First and Last Name here:
If you are completing this form on behalf of someone else, please provide YOUR Email Address *
Please select a time slot for when the registrant will be present at the CTU Center on your selected date to receive their COVID vaccination. (No one who arrives before 3pm will be turned away.) *
Do you have any additional questions?
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