COVID Vaccinations for ECUSD #1 Students 16 Years & Older

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The Whiteside County Health Department has reached out to the Erie School District to see how many of our students (ages 16 years and older) would like to receive a COVID vaccination.
Please only complete this survey if you wish to have your student receive a COVID vaccination. If you have multiple students that qualify, you will need to complete a survey for each student. This is to gauge interest to see what type of a clinic they could offer to students that wish to receive the vaccination. Completing this survey does not guarantee you a vaccination, a sign-up will follow with additional details based on level of interest. This form must be completed by 8AM on Monday, April 19th.

Email *

Name of Student *Must be 16 years of age or older and a student at Erie High School *

Name of parent/guardian completing this form *

Age of Student *

16 years

17 years

18+ years

Please choose a vaccination *

Pfizer (2 Doses at least 21 days apart - Individuals 16+)

Moderna (2 Doses at least 28 days apart - Individuals 18+)

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