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Vaccination Clinic Registration
Please use this form to register your child(ren) for the vaccination clinic. Registration will help us to ensure ample vaccines are available. Please complete one form for each child.
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* Indicates required question
Parent/Guardian First Name
*
Your answer
Parent/Guardian Last Name
*
Your answer
Phone Number (best number to reach you, include area code) (XXX-XXX-XXXX)
*
Your answer
Email Address
*
Your answer
Child's Name (first and last)
*
Your answer
Child's level in school?
*
Preschool
Elementary
Middle
High
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