Registration for Free COVID Vaccine Clinic, hosted by Boston Prep & Whittier Street Health Center
Free COVID Vaccine Clinic: Boston Prep will be hosting a free COVID-19 vaccination clinic at our school on Wednesday, June 15th from 11am-2pm for students, alumni, and faculty members. Here are a few additional details:
o First and second doses, as well as boosters, will be available for everyone ages 12 and up
o Both Pfizer and Moderna vaccines will be available
o Participants should plan to sit and wait for 15 minutes after receiving their vaccine
o Anyone who receives a vaccine will receive a $25 Stop and Shop gift card

Sign in to Google to save your progress. Learn more
What is your name? *
What is your email address? *
Who is getting vaccinated? *
If you responded "My student," please enter your student's name below. *
I understand that, in order for me/my student to receive this vaccination, I will need to complete a consent form prior to the 6/15 vaccination clinic (please look for the consent form coming to you via email in the next few days). *
Required
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Boston Preparatory Charter Public School.

Does this form look suspicious? Report