COVID Vaccination Clinic Pre-Registration
DeLaSalle is hosting a community vaccination clinic to provide a COVID-19 vaccine to anyone 12 years or older who is eligible to receive one. Please indicate your interest below if you plan to attend and receive a vaccine.

Those receiving a vaccine may choose from either the Pfizer/BioNTech, Moderna, or Johnson & Johnson vaccines. The Johnson & Johnson vaccine requires only one dose. The Pfizer/BioNTech and Moderna vaccines require two doses. DeLaSalle is planning a second vaccination clinic in several weeks to provide the second dose to those who receive their first dose on September 10.

Students who are younger than 18 must have a parent or guardian’s consent to receive the vaccine. A parent or guardian must be present on campus to permit their child under the age of 18 to receive the vaccine.
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Name (first and last) *
How many eligible people will receive the vaccine? *
Please select which vaccine you wish to receive. Please note: Only the Pfizer/BioNTech vaccine is fully approved for those ages 12 or older.
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