COVID-19 Vaccine Clinic at La Familia's Maple Community Center - May 20, 2021

If you live in Sacramento County and you meet the eligibility criteria for a vaccine, please use this form to register for an appointment with La Familia Counseling Center (3301 37th Ave Sacramento, CA 95824) on Thursday, May 20, 2021. Please note that you CAN NOT get the vaccine at this moment if you answer yes to questions 1-4.
Si vive en el condado de Sacramento y cumple con los criterios de elegibilidad para una vacuna, 
utilice este formulario para inscribirse en una cita con La Familia Counseling Center el jueves 20 de mayo de 2021.
Tenga en cuenta que NO PUEDE recibir la vacuna en este momento si responde afirmativamente a las
preguntas 1 a 4.
 
1) Are you currently feeling sick?/ ¿Se siente enfermo(a) actualmente? *
2) Have you had a positive test or has a doctor told you that you had COVID-19 in the past 90 days?/ Ha tenido una prueba positiva o un médico le ha dicho que tuvo COVID-19 en los últimos 90 días? *
3) Has the person to be vaccinated received passive antibody therapy as treatment for COVID-19 in the past 90 days?/ La persona que se va a vacunar ha recibido terapia con anticuerpos pasivos como tratamiento para COVID-19 en los últimos 90 días? *
4) Has the person to be vaccinated received any other vaccines in the past 14 days?/ La persona que se va a vacunar ha recibido alguna otra vacuna en los últimos 14 días? *
If you answered "YES" to the above questions, please DO NOT make an appointment.
 
Si respondió "SI" a las preguntas anteriores, por favor no haga una cita.

Personal Information / Información Personal

If you're younger than 18 years of age, you will NOT be able to get the Moderna Vaccine.
 
Si es menor de 18 años, NO podrá recibir la vacuna Moderna.
 
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Appointments Available / Citas Disponibles

All appointments will be at La Familia's Maple Community Center - 3301 37th Ave Sacramento, CA 95824. This is a walk-up vaccination clinic. Please wear a mask and bring an ID.

 
Dose Available/ Dosis Disponible *
Appointment Date/ Fecha de su Cita *
Time Slot/ Intervalo de tiempo *
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