COVID 19 Vaccine Clinic
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COVID 19 Vaccine Clinic
UPMC has reached out to the District to offer a FREE Covid-19 Vaccination Clinic to students 12 and older (parent consent will be required) and all community members.

The clinic will provide both shots of the Pfizer vaccine for free which would require two separate dates, May 19, 2021 and June 16, 2021.  Time from 12:00 - 2:00

We are asking that one survey be completed per household for those interested in receiving the vaccine.

*Required
1.  Full name of the person submitting this survey;* *
2.  Are there current Laurel Highlands students living in this household?* *
3.  Please list your best contact information (phone and/or email address)* *
4.  How many STUDENTS (12 years of age or older) from this household will receive the vaccine?
5. How many ADULTS from this household will receive the vaccine?
Parent Signature
Student Signature
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