Vaccination Clinic Interest Form (11-20-2021)
Litchfield Elementary School District is pleased to announce that we are partnering with Safeway/Albertsons to host two vaccination clinics to provide COVID-19 vaccines to eligible children and adults.  

Corte Sierra Elementary School (Gym)
3300 North Santa Fe Trail, Avondale
Saturday, November 20, 9:00 AM - 5:00 PM
Saturday, December 11, 9:00 AM - 5:00 PM

Pharmacy staff will be on site throughout the day to provide the recently approved pediatric Pfizer vaccine for children age 5 - 11 and the Pfizer vaccine for children and adults age 12 and older. All eligible children and adults are invited to participate. Booster shots will also be available.
 
Please complete this survey to help support our event planning. No appointments required.

*Bring proof of age for children age 5 - 6 (copy of birth certificate or passport)
*Bring completed Consent Form (attached)
*Bring proof of previous COVID-19 vaccinations (booster patients)
*Plan to wait 15 minutes after vaccination before being dismissed
*Insurance cards will not be required. There is no charge to anyone receiving the COVID-19 vaccine. (The last 4 digits of the patient’s SSN may be used for reimbursement purposes.)

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Will you or someone in your household participate in the vaccination clinic on Saturday, November 20, 2021? *
How many people in your household AGES 5 - 11 will participate in the vaccination clinic on Saturday, November 20, 2021? *
How many people in your household AGES 12 and UP will participate in the vaccination clinic on Saturday, November 20, 2021? *
How many people in your household will request a booster at the vaccination clinic on Saturday, November 20, 2021? *
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