Stars x HCHC: COVID-19 Vaccination Clinic
1st Dose
11/19:  3-6pm

2nd Dose
12/10:  3-6pm

For ages 5+ / Para edades 5+
Location: 500 E. Villa St Pasadena, Ca 91101

Please pre-register by filling out this form / Por favor preinscríbase completando este formulario
*please bring an identification with you* / *por favor traiga una identificación con usted*

+Boosters are available! *please bring your vaccination card with you* / +  vacunas de refuerzo estarán disponibles *por favor traiga su tarjeta de vacunas con usted*



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full name / nombre completo
address / dirección
phone number / numero de telefono
email adress / correo electrónico
date of birth / fecha de nacimiento
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Is this your first COVID-19 vaccine? / es esta su primera vacuna de COVID-19?
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for booster vaccines, please indicate which vaccine you need / para vacunas de refuerzo, por favor indique cual vacuna necesita
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date of your last COVID-19 vaccine  / fecha de su ultima vacuna de COVID-19
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Questions? / Preguntas?
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