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Vaccine/Booster Interest Form
Please Note: This is an interest form for COVID-19 vaccines and boosters for LVJUSD families and staff. The data collected may result in additional co-hosted COVID-19 vaccination clinics.
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* Indicates required question
First Name
*
Your answer
Last Name
*
Your answer
Email
*
Your answer
Phone Number
*
Your answer
School(s) your student(s) attend
*
Please select all that apply
Altamont Creek Elementary
Arroyo Seco Elementary
Christensen Middle School
Croce Elementary
Del Valle High School
East Ave. Middle School
Granada High School
Jackson Ave. Elementary
Joe Michell TK-8
Junction K-8
Lawrence Elementary
Livermore High School
Marylin Ave. Elementary
Mendenhall Middle School
Rancho Las Positas Elementary
Smith Elementary
Sunset Elementary
Vineyard Alternative
Required
Please use the drop-down menus to indicate the number of vaccines and/or boosters you are interested in receiving. You may skip any entries that do not apply.
Ages 5-11 Vaccine
Choose
1
2
3
4
5+
Ages 5-11 Booster
Choose
1
2
3
4
5+
Ages 12-17 Vaccine
Choose
1
2
3
4
5+
Ages 12-17 Booster
Choose
1
2
3
4
5+
Ages 18+ Family Member Vaccine
Choose
1
2
3
4
5+
Ages 18+ Family Member Booster
Choose
1
2
3
4
5+
LVJUSD Staff Vaccine
Choose
1
2
3
4
5+
LVJUSD Staff Booster
Choose
1
2
3
4
5+
Submit
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