Students and Family Vaccine Clinic Survey

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Hello 'Gansett Guardians, Students and Families,
Nursing has partnered with Community Health Connections to provide a vaccination clinic for all people in the community wishing to receive a vaccination. We will have Pfizer booster shots available as well as initial vaccinations for those wanting Johnson and Johnson, Moderna or Pfizer. Please take a minute to fill out this form if you are interested in being vaccinated at our clinic. If multiple people in your family or community want to be vaccinated, please fill out a separate form for each person so that vaccine can be reserved for them.
Be Well,
Myriah

First Name *

Last Name *

Email address *

How are you affiliated with the district *

Date of Birth

YYYY

Have you previously been vaccinated *

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