Sensory Friendly Vaccine Clinic Sign Up

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Date: November 21st | 3:30 - 7:00

Thank you for your interest in the Sensory Friendly Vaccine Clinic hosted in partnership by Thedacare, the Building for Kids Children's Museum, and Wisconsin Early Autism Project. This event will offer the Moderna vaccine series and Moderna and Pfizer boosters. Please complete a separate form for each individual registering for this event.

Please call us at (920) 558-4600 with any questions.

Email *

First & Last Name of Person Getting Vaccinated *

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Age (of Person Receiving Vaccine) *

Date of Birth (of person receiving vaccine) *

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Mailing Address

Please include Street Address, City & Zip Code

Telephone Number *

First & Last Name of Caregiver (If Applicable)

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