COVID Vaccine Clinic Signup

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Please select your preferred time slot to receive a COVID-19 vaccine (1st dose). Each time slot is capped for the maximum number of people for vaccines provided and only the visible time slots have available seats.

I understand that the Moline-Coal Valley School District will verify my student's age to ensure he/she is at least 12 years of age. My student will need to bring the following items to the clinic on the day of the event:
-drivers license, state ID, permit, or current school ID
-School Health Link vaccine consent form
-Moline-Coal Valley district permission form (required for those aged 12-17; preferred for 18+)

The first shots will be administered on July 15th at the John Deere Middle School Cafeteria. Your second does will automatically be scheduled for the same time slot on August 5th at the same location.

Staff or Student Student ID *

Staff or Student First Name *

Staff or Student Last Name *

Guardian Name (Student Only) *

Guardian Phone (Student Only) *

Guardian Email (Student Only)

Along with my student, I would like to request an additional vaccine for the number of adults selected (Optional)

Please Choose Your Preferred Time Slot for Thursday July 15th from the list below. *

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