Flu Vaccine Clinic Interest Survey
This survey assesses family interest in having children ages 9+ get influenza vaccine at either Hatfield Elementary School or Smith Academy after regular school hours in late October.  
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I would be interested in having my age 9+ child(ren)  vaccinated for influenza just after school in October
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Due to physical distancing requirements, I would be willing to have my age 9+ child(ren) wait with me in my car until called to the vaccination area.
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I understand and will assure that my child needs to wear a face mask in the vaccination area.
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If a Flu Clinic is scheduled, I will be able to provide all insurance information and permission forms prior to my child's appointment.
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I understand that influenza vaccine, like all medications, may have side effects with some being serious.  I will discuss these along with any questions or concerns directly with my child's pediatrician as appropriate prior to and after having my child vaccinated.  I understand further that the school is a possible host site for a Flu Clinic for my child, school nurses will not be administering the influenza vaccine, and that local pharmacy staff will provide and administer the vaccine.
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(Optional):  I have other questions or concerns related to having my child(ren) particpate in a school-hosted influenza vaccination clinic.  Please contact me at the email address below:
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