Flu Clinic - City of Waterbury

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Dates: October 4th- October 8th, 2021
Contact us at (203) 574-6844 or benefits@waterburyct.org

This form is being used for those who would like to register for the upcoming Flu Clinic. CVS is offering this vaccine to our employees and in order for them to have enough supplies, we need individuals to pre-register. Please complete the form once. If you would like to register multiple individuals, please go in separately and enter in that individuals name and information.

Name (First and Last) *

Email (please provide best email for us to send consent form and updates to your registration) *

City Hall October 4, 2021 9:00am - 11:30am

Wilby High School October 4, 2021 1:00pm - 3:30pm

Public Works October 5, 2021 10:00am - 12:30pm

Kennedy High School October 5, 2021 2:00pm - 4:30pm

Police Dept October 7, 2021 9:00am - 11:30am

Crosby High School October 7, 2021 1:00pm - 3:30pm

One Jefferson Building October 8, 2021 9:00am - 11:30am

Waterbury Career Academy October 8, 2021 1:00pm - 3:30pm

There are 2 types of Flu Shots. Which one would you like to take? *

Regular Flu Shot

Over Age 65 Flu Shot

I understand that I will need to have my insurance card (Cigna or other insurance) available at the time of my clinic. For proof of vaccine, please bring your phone to take a picture. *

Yes

Required

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