LHS Student Vaccination Intent Form

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We are planning for our vaccine clinics with Nationwide Children's Hospital and would like to gather data regarding how many students are planning to participate.

Please complete this form to indicate your intent to have your 16-18+ year old student(s) participate. If your student has already turned in a consent form, you do not need to complete this survey. To access the consent form that must be turned in by Tuesday, April 13, please pick up a paper copy in the main office or use the link below to print one yourself.

https://drive.google.com/file/d/1t6YOJh-GQVeH1jlSzSh1DxD1COcxbwb5/view

Please select the option below if you intend to have your student participate in the vaccination clinic at Lincoln High School. *

My student intends to turn in the vaccination consent form to the Lincoln High School main office by Tuesday, April 13 in order to participate in the vaccine clinic..

Student First Name *

Student Last Name *

Student's Age *

Student's Grade Level *

9th Grade

10th Grade

11th Grade

12th Grade

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