COVID-19 Vaccination Registration Form -  Saturday, December 4 (5-11 year olds)
This form is used to sign up and receive a COVID-19 vaccination with the Thornton Fire Department.  A parent or legal guardian must fill out the form for their child and give consent. You may edit your responses after you submit.

Appointments are necessary for a faster check-in process and limited parking. THE CLINIC WILL BE HELD FROM  9 - 4PM at Fire Station 5, 14051 Colorado Boulevard. Please park in the south parking lot at one of the signs and follow the instructions on the signs. You will be asked to text information so please bring a phone.

Do not get out of your vehicle, we will come out to you.  

Please have your child wear a short sleeve shirt and have their jacket removed before a staff member greets you at your vehicle.

** You will not receive an email confirmation, you will receive an onscreen confirmation once you hit submit and a copy of your submission will be emailed to you.

Some helpful tips for you and your child:

* Discuss where they are going and the importance of receiving the vaccine.
* Prepare them for a poke, avoid using the word shot.
* Parents - stay cool, calm and collected.
* If needed,  move yourself to the passenger seat and place the child in your lap (comfort hold).
* Bring a comfort item as a distraction (stuffed animal, iPad, etc.).
* Consider using a topical coolant spray.
* It is suggested to leave siblings at home, if possible, and have one parent accompany the minor.
* Most important - be honest (will only hurt for a second, will feel a pinch, etc.)

Have your child prepared to receive the vaccination before the staff member arrives at your vehicle, if they are not prepared we will come back to your vehicle.

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Email *
Legal Last Name of Minor (do not use parent name) *
Legal First Name of Minor (do not use parent name) *
Street Address *
City *
State *
Zipcode *
Phone Number *
Gender *
Date of Birth *
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DD
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Do you agree child is between the ages of 5-11 to receive Pfizer? *
Please indicate if this is your 1st or 2nd dose *
Date of 1st Dose
MM
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DD
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YYYY
Please select an appointment time
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