MaineHealth's COVID Vaccine Registration Form

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MaineHealth's COVID Vaccine Registration Form

If you choose to have your child(ren) ages 5-11 vaccinated, please complete ONE FORM PER CHILD. This information will be utilized to create, or update, MyChart through MaineHealth and will allow an expedited process on the day of the clinics.

Please Note: You MUST ALSO COMPLETE the Consent Form and Choose an appointment time on Sign-up Genius for your registration to be complete.

Thank you.

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Parent's FULL Name *

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Parent Phone Number *

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This form was created inside of Biddeford School Department. Report Abuse