COVID-19 vaccination for children ages 6 months to 4 years (under 5)

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Please answer this survey if you have children ages 6 months through 4 years (under 5) who you plan to have vaccinated against COVID-19. Your answers will help us plan for clinics when COVID-19 vaccines are authorized for use in this age group. Not all of the options listed may be available.

Child #1 age: *

6 months - under 1 year

1 year to under 2 years

2 years to under 3 years

3 years to under 4 years

4 years to under 5 years

Child #1: *

I will have my child vaccinated against COVID-19 as soon as the vaccine is available.

I will have my child vaccinated against COVID-19, but will wait a few months.

I am not sure yet if I will have my child vaccinated against COVID-19.

I am not currently planning to have my child vaccinated against COVID-19.

Child #2 age:

6 months - under 1 year

1 year to under 2 years

2 years to under 3 years

3 years to under 4 years

4 years to under 5 years

Clear selection

Child #2:

I will have my child vaccinated against COVID-19 as soon as the vaccine is available.

I will have my child vaccinated against COVID-19, but will wait a few months.

I am not sure yet if I will have my child vaccinated against COVID-19.

I am not currently planning to have my child vaccinated against COVID-19.

Clear selection

Child #3 age:

6 months - under 1 year

1 year to under 2 years

2 years to under 3 years

3 years to under 4 years

4 years to under 5 years

Clear selection

Child #3:

I will have my child vaccinated against COVID-19 as soon as the vaccine is available.

I will have my child vaccinated against COVID-19, but will wait a few months.

I am not sure yet if I will have my child vaccinated against COVID-19.

I am not currently planning to have my child vaccinated against COVID-19.

Clear selection

I would be comfortable having my child(ren) vaccinated at (choose all that apply): *

A clinic at a pediatric healthcare provider's office

Health Department clinic

Pharmacy (age 3+)

Mobile vaccination clinic

Other:

Required

My child/children's healthcare provider/office is:

The best time(s) for my family to come to a vaccination clinic would be (choose all that apply):

Weekday morning

Weekday afternoon

Weekday evening

Saturday morning

Saturday afternoon

My family lives in:

Central Carroll County (Westminster, Finksburg)

Northern Carroll County (Hampstead, Manchester)

Southern Carroll County (Sykesville, Eldersburg, Mount Airy)

Western Carroll County (Taneytown, Keymar, New Windsor, Union Bridge)

We don't live in Carroll but spend time here (work, family, church, medical care, etc)

Clear selection

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