COVID-19 Vaccine Clinic at Walnut Grove Elementary - December 17, 2021

Have you received the COVID Vaccine? / ¿Ha recibido la vacuna COVID? *

If you're receiving your Booster, it has to be 6 months after completing your primary COVID Vaccination series. (J&J will require 2 months)

Si esta recibiendo su 3a vacuna (Booster), es su deber esperar seis meses despues de haber recibido su serie primaria de vacunas para COVID. (se requiere 2 meses despues de la vacuna J&J).

Which vaccine did you previously receive? / ¿Qué vacuna recibió anteriormente?

Personal Information / Información Personal

If you're younger than 18 years of age, you MUST be accompanied by a parent/guardian to receive the COVID-19 Vaccine.

Si es menor de 18 años, DEBE estar acompañado por un padre / tutor para recibir la vacuna COVID-19.

First Name/Primer Nombre: *

Last Name/Apellido: *

Date of Birth/Fecha De Nacimiento: * +

Gender/Genero: *

Driver License #

Address/Direccion *

City/Ciudad *

Zip Code/Codigo Postal: *

County *

Phone Number/Numero De Telefono:: *

Email Address/ Correo Electronico

Race/Raza: *

Ethnicity/Etnia: *

Language/Idioma: *

Parent's Name/Nombre del Padre or Madre *

Appointments Available / Citas Disponibles

All appointments will be at Walnut Grove Elementary - 14181 Grove St. Walnut Grove, CA 95690. This is a walk-up vaccination clinic. Please wear a mask and bring an ID. If the person getting vaccinated is younger than 18 years of age, they must be accompanied by a parent/guardian.

Todas las citas seran en Walnut Grove Elementary - 14181 Grove St. Walnut Grove, CA 95690. La clinica de vacunacion es en persona, no en carro. Porfavor use mascarilla y traiga su ID. Si la persona que se va a vacunar es menor de 18 años, los padres tienen que estar presente.

Appointment Date/ Fecha de su Cita *

Friday, December 17, 2021

Dose Available/ Dosis Disponible *

Pfizer (1st Dose)

Pfizer (2nd Dose)

Pfizer (Booster)