Covid-19 Vaccine for Community


Sign in to Google to save your progress. Learn more
Email *
Dear ASD Community:    We were just informed that we can offer COVID-19 vaccination shots to our Deaf community and families.  A local pharmacy, Freiderica Pharmacy and Compounding, will come to ASD to give the shots.                                                                                                                                                                                                                                                          Do you want a shot?   If so, you will need to fill out the form below. The shot is FREE.  Your insurance will pay.                                                                                                                                                                                     We will TEXT YOU a special invitation with your appointment time.  You will need to come to the Leopard Spot (Tornado Shelter) for your shot.
Your Name *
Your Phone Number (We will TEXT the Appointment Time) *
Date of Birth *
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of Arkansas School for the Deaf. Report Abuse