East - Student COVID-19 Vaccine Interest Survey 4-22-21
East Families,
We are reaching out to you gauge your interest in having your student receive a COVID 19 vaccination.  Because we want to follow up and support you, the responses to this survey are not anonymous.  You do not need to complete this survey if your student already has been vaccinated, has a vaccine appointment, is not interested in a vaccine or you do not want to share information about your student's vaccination progress.  

Email *
Are you interested in a vaccination appointment for your student? *
If you answered "yes" please provide the names, ages and ID numbers for your student (s).  If "no" you do not need to complete the rest of this survey.
Student 1 Name
Student 1 ID Number
Student 1 Age
Student 2 Name
Student 2 ID Number
Student 2 Age
Student 3 Name
Student 3 ID Number
Student 3 Age
Does your student(s) already have a vaccine appointment at a vaccine clinic?  
Clear selection
Please provide the email that you will be monitoring closely where we can contact you if we have information about available vaccination appointments.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This form was created inside of Glenbard High School District #87. Report Abuse
Google Forms