Dose-Chella II Immunization Day
Children's School Services is partnering with Friendship PCS to host an Immunization Day for Friendship families and the community on Saturday, September 10, 2022 at Friendship Blow Pierce Campus located at 725 19th St NE, Washington, DC 20002. The Mobile Van is like any other Doctor's office and can administer needed childhood immunizations to your child. To sign up for an appointment, fill out this form.

There will be food trucks, games and giveaways at this event.

Please complete one form per scholar.

If you have any questions, please email wecare@friendshipschools.org.

Sign in to Google to save your progress. Learn more
Student First Name *
Student Last Name *
School Name *
Required
Student Grade *
Required
Date of Birth *
MM
/
DD
/
YYYY
Health Insurance *
Name of Provider
Health Insurance Member ID
Parent/Guardian Name *
Parent/Guardian Email *
Parent/Guardian Phone Number *
Home Address *
Preferred Appointment Time *
Select 2 different appointment times that could work for you on Saturday, August 20, 2022. Please keep in mind, a parent/guardian needs to be with the child at the appointment. Appointment time confirmation will be sent after filling out this form.
Required
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Friendship Public Charter Schools. Report Abuse
Google Forms