Students and Family Vaccine Clinic Survey
Hello 'Gansett Guardians, Students and Families,
Nursing has partnered with Community Health Connections to provide a vaccination clinic for all people in the community wishing to receive a vaccination. We will have Pfizer booster shots available as well as initial vaccinations for those wanting Johnson and Johnson, Moderna or Pfizer. Please take a minute to fill out this form if you are interested in being vaccinated at our clinic. If multiple people in your family or community want to be vaccinated, please fill out a separate form for each person so that vaccine can be reserved for them.
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How are you affiliated with the district
Family of Staff
Date of Birth
Have you previously been vaccinated
Yes, I want a Pfizer booster shot
Yes, but I am not finished with the full series
No, I have not been vaccinated yet
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This form was created inside of Narragansett Regional School District.