Pfizer COVID-19 Vaccine Interest Survey / Encuesta de interés sobre la vacuna de COVID-19 de Pfizer

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Hello Uplift family! We will be hosting three FREE COVID-19 Pfizer Vaccine Drives on Friday, July 23rd and Saturday, July 31st for everyone in our Uplift community 12 and up. Please indicate whether you are interested in receiving the Pfizer COVID-19 vaccine. Based on the the number of people interested, our partnering medical provider will be able to provide us with an adequate number of vaccines. Thank you.

¡Hola familia de Uplift! Estaremos teniendo tres clinicas GRATUITAS de vacunación de COVID-19 de Pfizer el viernes 23 de julio y el sábado 31 de julio para todos en nuestra comunidad de Uplift de 12 años en adelante. Indique si está interesado en recibir la vacuna de Pfizer de COVID-19. Según la cantidad de personas interesadas, nuestro proveedor médico asociado podrá proporcionarnos una cantidad adecuada de vacunas. Gracias.

First and last name / Primer nombre y apellido *

Email address / Correo electrónico *

Telephone Number / Numero de teléfono

Are you, or a member of your family 12 and older, interested in receiving the Pfizer COVID-19 vaccine? / ¿Está usted, o un miembro de su familia mayor de 12 años, interesado en recibir la vacuna de COVID-19 de Pfizer? *

Yes / Si

No / No

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Which clinic will you attend? (Please only select one) /¿A qué clínica asistirás? (Seleccione solo una) *

Friday, July 23rd (4pm-6pm) Uplift Atlas (Secondary Gymnasium) 4600 Bryan Street, Dallas, Texas 75204

Saturday, July 31st (8am-11am) Uplift Wisdom Preparatory - 301 W. Camp Wisdom Rd., Dallas, TX 75232

Saturday, July 31st (12:30 pm- 3pm) Uplift Mighty Preparatory 3700 Mighty Mite Drive, Fort Worth, Texas 76105

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