Vaccine for 12+ Students Interest Survey

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The Monroe County Health Department is working to procure doses of the Pfizer vaccine to vaccinate all interested Monroe County youth ages 12 and up. We will be announcing sites based on your needs. We are excited about providing this opportunity to students.

Students under the age of 18 MUST have a parent/guardian accompany them to the vaccination appointment.

PLEASE COMPLETE A SURVEY FOR EACH STUDENT AGE 12 OR OLDER.

Please complete the short survey below to indicate your interest in taking part in this opportunity.

Email *

I am an MCSD student or the Parent/ Guardian of an MCSD student who is: *

Twelve (12) years of age or older

less than twelve (12) years of age

I am not an MCSD student or Parent/ Guardian of an MCSD student

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