Vaccine Clinic Transportation Request Form
In partnership with Nationwide Children’s Hospital, Bexley City Schools will host a vaccine clinic for children ages 5-11. This clinic will be available for all families in our Bexley community, not just limited to Bexley City Schools students.

The clinic will be held in the cafeteria within the Cassingham Complex (300 S. Cassingham Rd. Bexley, OH) from 5 to 8 p.m. on Thursday, November 18. Students will be given the second shot on Thursday, December 9.

We are offering transportation to ensure families that want their student(s) to be vaccinated at our clinic are able to do so. Please fill out this form so we can best coordinate picking up children. *One parent/guardian must accompany the child.*

We will contact you with more details about transportation once you have signed up.
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Parent/guardian name
Parent/guardian email
Parent/guardian phone number
Student(s) name
Pick-up/drop-off address
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