COVID Vaccination Interest Survey
Students are NOT required to take the COVID-19 Vaccination. This is only an opportunity for you and your child. Please complete the following survey ONLY if you are interested in you or your child receiving the COVID-19 Vaccination or if your child is already vaccinated.  Knowledge of your child being vaccinated allows the district insight during contact tracing for quarantining students.  Vaccinated students and staff DO NOT have to quarantine after an exposure.  If you have multiple children, please complete the survey for each child. Qualifying students are those who are over 12 years of age. Also, any Menifee County Resident who has not been vaccinated and is interested in receiving the vaccination, may complete the survey and indicate that you are not a student. This survey is for planning purposes only and does not guarantee access to a vaccine. Additional information will be shared with those interested.  

Please visit the Mayo Clinic website for more information regarding vaccinations for students.

https://www.mayoclinic.org/diseases-conditions/coronavirus/in-depth/covid-19-vaccines-for-kids/art-20513332#what-vaccine

Sign in to Google to save your progress. Learn more
Last Name *
First Name *
Is the person listed above a student? *
Date of Birth *
MM
/
DD
/
YYYY
Phone Number *
My child is fully vaccinated
Clear selection
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Menifee County School District. Report Abuse