Pfizer Vaccination Interest Form / Formulario de interés de vacunación de Pfizer

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GUSD in collaboration with Salinas Valley Memorial Hospital are offering the Pfizer vaccination for students that are 16 year old and above. The clinic will be held on April 27th at the Taylor Farm Clinic. More information will be shared with students, parents/guardians that complete this interest form.

This survey is due by April 22nd at 12:00 PM

GUSD, en asociación con Salinas Valley Memorial Hospital, está ofreciendo la vacuna Pfizer para estudiantes de 16 años o más. La clínica se llevará a cabo el 27 de abril en Taylor Farm Clinic. Se compartirá más información con los estudiantes, padres / tutores que completen este formulario de interés.

Esta encuesta vence el 22 de abril a las 12:00 p.m.

Last Name *

First Name *

Middle Initial *

Date of Birth *

YYYY

Street Address *

City *

Zip Code *

Phone Number *

e-mail address *

Gender

Do you have health insurance? *

Yes

Submit

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