Vaccination Event Sign-up
District 23 is partnering with the Cook County Department of Public Health to provide Flu and COVID vaccines to our community on Saturday, December 3 from 8:30-11:30am at Eisenhower School. Please complete this form to sign-up for this event and indicate which vaccine you would prefer. We will share the information with CIMPAR, the agency providing the vaccinations, so they can bring the appropriate doses.

Staff members will ask for insurance information, but nobody will be turned away, we still will be providing the COVID vaccine for those without insurance. The FLU VACCINES will be provided to those individuals with insurance only. No, exceptions. 
Last Name
Please indicate how many of each type of vaccine your family would prefer. If "Not Applicable", you can leave this answer blank. 
FLU Shots High dose (65+) 
Please indicate how many of each type of vaccine your family would prefer. If "Not Applicable", you can leave this answer blank. 
FLU Shots Regular dose (under 65+) 
Please indicate how many of each type of vaccine your family would prefer. If "Not Applicable", you can leave this answer blank. 
 Baby Pfizer 1st dose (6 months- 4 years old)
Please indicate how many of each type of vaccine your family would prefer. If "Not Applicable", you can leave this answer blank. 
 Baby Pfizer 2nd dose (6 months- 4 years old)
Please indicate how many of each type of vaccine your family would prefer. If "Not Applicable", you can leave this answer blank. 
 Baby Pfizer 3rd dose (6 months- 4 years old)
Please indicate how many of each type of vaccine your family would prefer. If "Not Applicable", you can leave this answer blank. 
 Baby Moderna 1st dose (6 months- 5 years old)
Please indicate how many of each type of vaccine your family would prefer. If "Not Applicable", you can leave this answer blank. 
 Baby Moderna 2nd dose (6 months- 5 years old)
Please indicate how many of each type of vaccine your family would prefer. If "Not Applicable", you can leave this answer blank. 
Pfizer Pediatric 1st dose (5- 11 years old) 
Please indicate how many of each type of vaccine your family would prefer. If "Not Applicable", you can leave this answer blank. 
Pfizer Pediatric 2nd dose (5- 11 years old)
Please indicate how many of each type of vaccine your family would prefer. If "Not Applicable", you can leave this answer blank. 
 Pfizer Pediatric booster (5- 11 years old)
Please indicate how many of each type of vaccine your family would prefer. If "Not Applicable", you can leave this answer blank. 
Pfizer 1st dose & 2nd dose
Please indicate how many of each type of vaccine your family would prefer. If "Not Applicable", you can leave this answer blank. 
Pfizer BIVALENT (6-11 yrs only)
Please indicate how many of each type of vaccine your family would prefer. If "Not Applicable", you can leave this answer blank. 
Pfizer BIVALENT (12+/Adults only)
Please indicate how many of each type of vaccine your family would prefer. If "Not Applicable", you can leave this answer blank. 
Moderna 1st & 2nd dose
Please indicate how many of each type of vaccine your family would prefer. If "Not Applicable", you can leave this answer blank. 
Moderna BIVALENT Booster (6-11 yrs only) 
Please indicate how many of each type of vaccine your family would prefer. If "Not Applicable", you can leave this answer blank. 
Moderna BIVALENT Booster (12+/Adults only) 
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