Covid Vaccination Pop-Up #2
This is an informational survey only to help us try to plan for the clinic on Monday Dec. 6 (scheduled for 7:30 am - 4:30 pm at the ICT site at 512 Carroll Street.)

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In order to plan, we are hoping to have an idea of how many families would like to get their 2nd shot at our school site and if you got shot #1, but do not plan to attend for shot #2 on Monday that is also helpful information.  Please fill out the form below, which does not guarantee a spot, it is for planning purposes. Your responses will be helpful for administration to know.


From the Konstella announcement: DOE guidance has shared the round 2 vaccine is primarily for students that received the vaccine in round 1 at the school.  If there are additional doses available, they may be administered on a first come first served basis. We have not been informed of the exact number of doses that will be available.

Please note that you must be present with your child during the entire process to receive the vaccine (we will not call students down from class). Please be mindful of inclement weather as parents cannot wait inside the building. You will need to complete a health screener and show proof of vaccine.

 For any questions, please contact Josh Baez (Joshua.Baez@ps372.net)


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Parent/Guardian Name *
Parent/Guardian Email *
Did your child(ren) get their first shot at school? *
Are you planning to come to the pop-up on Monday?
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If yes, which dose do you need?
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Child 1 Name
Child 1 class
Child 2 name
Child 2 class
Child 3 name
Child 3 class
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