Feb. 11 COVID-19 Vaccine Clinic
Bauxite Schools, in conjunction with Westside Pharmacy, will offer a free COVID-19 Vaccine Clinic on Feb. 11 from 2:30 - 4:30 at the high school cafeteria. It is open to anyone, but we would like to get an approximate count of how many people would like to participate so the pharmacist brings the correct number of vaccines. This is the Pfizer vaccine, and it is the same vaccine whether it is the first shot, second shot, or a booster. Sign up below with your name and phone number if you plan to participate. For children under 12, a parent or guardian must be present. You may print and bring the form or fill it out at the clinic. https://westsidepharmacybenton.com/wp-content/uploads/2021/03/WS-Pharmacy-COVID-19-Vaccine-Consent-Form-UPDATED.pdf
Sign in to Google to save your progress. Learn more
Email *
I would like to receive a vaccine at the the Feb. 11 shot clinic at Bauxite High School cafeteria between 2:30 and 5:30. My name (or my student's name). *
Approximately what time do you plan to attend the shot clinic? *
Time
:
My phone number *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Bauxite School District. Report Abuse