Flu Vaccines for Children Registration Form 2023

Thank you for registering your child for our flu vaccination clinic at the Carroll County Health Department. Our flu vaccination clinics will be held on October 16th and 18th from 4pm to 6pm.

  • Our children's flu vaccination clinics are open to all children 6 months through 18 years of age regardless of insurance status.  
  • The vaccine is provided at no cost by the Vaccines For Children (VFC) program.
  • We will collect insurance information so we can bill your child's insurance for a vaccine administration fee (not for the vaccine). 
  • Your child does not have to be insured to receive a flu vaccination at this clinic. There may be a small vaccine administration fee if your child does not have insurance. No one will be turned away based on their ability to pay.

Please fill out this form to request an appointment. Someone will call you at the number provided within 72 hours to schedule your appointment.

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Email *
Child's last name *
Child's first name *
Child's middle name
Is your child age 18 or younger?  *
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