COVID-19 Student Vaccination Registration
The Clinton County School District, together with the Healthy Kids Clinic, will offer a COVID-19 vaccination clinic for Clinton County students, ages 12 & up.  The vaccine is OPTIONAL.  The Pfizer (2-dose) vaccine will be FREE. Parents / guardians are responsible for transporting students to the vaccine clinic.  Parents / guardians must sign a consent form before the first dose is administered.  The first clinic will be held in the Clinton County Middle School gymnasium on Monday, August 9, 2021 from 12:00 NOON - 5:00 PM.  Please complete one registration for EACH STUDENT.

Once you complete this form, you will be contacted by phone the week prior to the first clinic to schedule your appointment. If you do not have access to transportation, please indicate that on the last question.
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Student Name
Age of student
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School Student Attends (21-22 School Year)
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Parent / Guardian Name
Contact Phone Number
What is your preferred time range for your child's appointment?
Do you have access to transportation for yourself and your child to the clinic?
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