COVID Vaccine Clinic Signup

Please select your preferred time slot to receive a COVID-19 vaccine (1st dose).  Each time slot is capped for the maximum number of people for vaccines provided and only the visible time slots have available seats.  

I understand that the Moline-Coal Valley School District will verify my student's age to ensure he/she is at least 12 years of age.  My student will need to bring the following items to the clinic on the day of the event:
   -drivers license, state ID, permit, or current school ID
   -School Health Link vaccine consent form
   -Moline-Coal Valley district permission form (required for those aged 12-17; preferred for 18+)

The first shots will be administered on August 5th at the John Deere Middle School Cafeteria from 8a - 12p.  Your second does will automatically be scheduled for the same time slot on August 26th from 1-4 pm at Bartlett Performing Arts Center.
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Student ID (located on student's ID or under the student profile in Skyward) *
Student First Name *
Student Last Name *
Guardian Name *
Guardian Phone *
Guardian Email
Along with my student, I would like to request an additional vaccine for the number of adults selected (Optional)
Please Choose Your Preferred Time Slot for Thursday August 5th from the list below. *
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