Flu Shot Pre-Registration

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Thank you for registering for this Fall's Flu Shot Clinics! Please answer all of the following questions. Our medical staff looks forward to seeing you at the event! Be sure to wear a face covering and have your S# handy. ***Full-time employees will need to have a printed copy of their insurance cards at the time of event.***
Please feel free to email chc@slcc.edu if you have any questions.

What is your name? *

What is your email? *

Are you a student or employee? *

Student

Part-time employee

Full-time employee

What is your S Number? *

Which event do you plan on attending? *

September 14th, 10:00-2:00 pm @ South City Campus

September 28th, 10:00-2:00 pm @ Jordan Campus

September 30th, 10:00-2:00 pm @ Taylorsville/Redwood Campus

October 14th, 10:00-12:00 pm @ West Valley Campus

How did you hear about these events?

Social Media

Printed flyers

Digital advertising

Word of mouth

Other

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