VACCINATION CLINIC AT DATA: FEB 11, 2022
I hope you are doing well and staying healthy. Charter School Nursing Services (CSNS) has organized a vaccination clinic to be held at DATA Friday, February 11th from 8:00-12:00. In collaboration with Charter School Nursing Services, DATA will be offering the Flu Vaccine, COVID-19 Vaccine (for persons 5 years and older) and the COVID-19 Booster (criteria include persons 12 and older).

In preparation for the clinic, the CSNS is asking for specific information and the number of vaccines to bring. Please take 1-2 minutes to let us know if you are interested in coming to DATA for your vaccination and let us know which vaccine(s) you will need. Also, let us know if anyone in your family will be joining you and which vaccines they will need as well.

NOTE:  Only those coming to the clinic will need to complete this survey. The CSNS is able to vaccinate children without their parents present provided the parent has signed the child's consent form ahead of time. I will send the forms as the vaccination clinic date draws near.

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Email address *
Name of Person 1 Being Vaccinated *
Vaccine Option(s) for Person 1 (click all that apply)
Name of Person 2 Being Vaccinated
Vaccine Option(s) for Person 2 (Click all that apply)
Name of Person 3 Being Vaccinated
Vaccine Option(s) for Person 3 (Click all that apply)
Name of Person 4 Being Vaccinated
Vaccine Option(s) for Person 4 (Click all that apply)
Name of Person 5 Being Vaccinated
Vaccine Option(s) for Person 5 (Click all that apply)
Name of any other family members and requested vaccination(s)
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