Sunday, October 2nd: FREE COVID-19 Vaccine Sign-Up

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Event Timing: Sunday, October 2nd, 2022 from 12:00 noon - 1:30pm
Event Address: 16th Street 7th Day Adventist Church, 1601 W. 16th St, San Bernardino CA 92411
Questions? Contact us at (909)887-3900 or Lking@copesite.org

Offering Pfizer vaccine to individuals 12+ (all doses available).

Eligibility:
- Ages 12+. Parent/guardian must be present for ages 12 -17.
- Everyone is eligible for COVID-19 vaccination, regardless of immigration or insurance status.

What to bring: Bring your ID if you have one, insurance card if you have one, and vaccine card for second doses or booster shots. Walk-ins are also welcome.

Please complete this form for EACH person in your family who will be getting vaccinated.

First Name *

Last Name *

Birth Date *

YYYY

Age *

12 - 17 (Parent/guardian must be present)

18+

Street Address *

City *

Zip Code *

Phone Number *

This will be my... *

First dose

Second Dose

Booster Dose (must be 18+)

Third Dose (for immunocompromised)

Preferred Language

English

Spanish

Other:

Clear selection

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