Student Vaccinations - Lakewood School District (Pfizer)
As of Monday, April 19th, all individuals aged 16 and older will be eligible for the COVID-19 Vaccine.

If you are a Lakewood School District Student, Public or Nonpublic, and are 16 years of age or older, and would like to receive the COVID-19 vaccine, please register using this link!

Dates for the COVID-19 Vaccine:


Thursday, April 22, 2021 - 5:30 p.m. to 7:30 p.m.

Where:  Woodlake Country Club, 25 New Hampshire Ave

Needed:   Parents need ID and Insurance Card (If Applicable)

_______________________________________________________________________________________________________

A partir del lunes 19 de abril, todas las personas mayores de 16 años serán elegibles para la vacuna COVID-19.

Si usted es un estudiante del distrito escolar de Lakewood, público o no público, y tiene 16 años de edad o más, y le gustaría recibir la vacuna COVID-19, ¡regístrese usando este enlace!

Fechas de la vacuna COVID-19:


Jueves 22 de abril de 2021 - 5:30 p.m. a las 7:30 p.m.


Dónde: Woodlake Country Club, 25 New Hampshire Ave

           
Necesario: los padres necesitan identificación y tarjeta de seguro (si corresponde)


Sign in to Google to save your progress. Learn more
Last Name of Student/Apellido del estudiante: *
First Name of Student/Nombre del estudiante: *
School Student Attends/Estudiante de la escuela asiste: *
Date of Birth of Student/Fecha de nacimiento del estudiante: *
MM
/
DD
/
YYYY
Street Address of Student *
Township student resides in (Lakewood, Toms River, etc.): *
Eligibility Criteria/Criterio de elegibilidad: *
I would like to schedule an appointment for the COVID-19 Vaccine on/Me gustaría programar una cita para la vacuna COVID-19 el: *
My email address is/Mi correo electrónico es:: *
Confirm email address/Confirmar el correo: *
You will receive an email confirmation of the date and time that you have been scheduled for your COVID-19 vaccine!  Thank you!/¡Recibirá una confirmación por correo electrónico de la fecha y hora en que se le ha programado su vacuna COVID-19! ¡Gracias! *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Lakewood Board of Education. Report Abuse