Polk Schools Student COVID 19 Vaccine Survey

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Please complete this survey ONLY if you are interested in your child receiving a Pfizer COVID 19 vaccine at one of our schools. This survey is anonymous and will be used for planning purposes only. Parent permission is required for any child to receive a vaccine.

How many children (12 years of age or older) would you like to receive the COVID 19 vaccine? *

5 or more

Where would you like for your child to receive the vaccine? *

Polk County High School

Polk County Early College

Polk County Middle School

The elementary school in my community

Some other location not at a school

Please submit any questions you have about the vaccine or the school vaccine events we are planning.

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