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Covid 19 Vaccine Form
College Achieve Paterson Charter School will host a Covid-19 Vaccination Forum with the Passaic County Health Department and Assemblywoman Shavonda Sumter. Parents are welcome to ask any and all questions related to the Covid-19 Vaccines.
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Email
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Your email
Have you received your Covid-19 Vaccine?
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Yes
No
Are you interested in receiving the Covid-19 Vaccine?
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Yes
No
Not Sure
Which vaccine did you receive?
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Pfizer
Moderna
Johnson & Johnson
Not yet vaccinated
Are you interested in having your family vaccinated?
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Yes
No
Not Sure / Uncertain
When the time comes , will you be interested in getting your scholar(s) vaccinated?
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Yes
No
Unsure
Does your scholar attend College Achieve Paterson Charter School?
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Yes
No
Do you have any questions for the medical professionals on the Covid-19 Vaccines?
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Your answer
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