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Vaccine Appointments at St. Paul Church Tuesday, Jan. 18, 2:30-5:30
Please complete this form to signup for a COVID-19 vaccine at:
St. Paul Church
3912 Gus Young Ave,
Baton Rouge, LA 70802
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First name:
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Last Name:
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Street address (#### Street)
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Zip code
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Cell Phone (including area code; so we can text you a reminder.)
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Email address
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Which dose are you receiving?
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First dose
Second dose
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If you would like to register additional members of your household, please list their full name(s) below in the space provided:
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