Vaccine Clinic Registration Form (Ages 5-11)  Formulario para registro de la clínica de vacunas (edades 5-11) DATE: JANUARY 13th or 14th
Attention Eagle Pass ISD parents,

Eagle Pass ISD is coordinating with the Emergency Operation Center and United Medical Centers to offer students, 5 to 11-year-old, the opportunity to be vaccinated with the Pfizer COVID-19 vaccine at their home campus on Thursday, January 13, 2022 and Friday, January 14, 2022.

If you are interested in your 5 to 11-year-old child receiving the Pfizer COVID-19 vaccine at one of the EPISD campuses, please complete the registration below.

Campuses will be sending out permission slips for those that register with location, date and time early next week.

If you previously registered pleas do not submit a second registration.

Thank you

Atención padres de Eagle Pass ISD,

Eagle Pass ISD está coordinando con el Centro de Operaciones de Emergencia y United Medical Centers para ofrecer a los estudiantes, de 5 a 11 años, la oportunidad de vacunarse con la vacuna Pfizer COVID-19 en su campus de origen el jueves 13 de enero de 2022 y Viernes 14 de enero de 2022.

Si está interesado en que su hijo/a de 5 a 11 años reciba la vacuna Pfizer COVID-19 en uno de nuestros planteles, complete la formulario a a continuación.

Los planteles enviarán formularios de permiso para aquellos que se registren con la ubicación, fecha y hora a principios de la próxima semana.

Gracias
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Email *
School / Escuela *
Student ID (example 12345) / Número de identificación de estudiante (ejemplo 12345) *
Student's First Name / Nombre del estudiante *
Student's Last Name / Apellido del estudiante *
Parent’s First Name / Primer nombre del padre *
Parent's Last Name / Apellido de los padres *
Phone # / Teléfono # *
A copy of your responses will be emailed to the address you provided.
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