COVID-19 Vaccine Interest Survey 5-11

Harrison Central School District

COVID-19 Vaccine Interest Survey
The Harrison Central School District is seeking a partnership with Westchester County to host a COVID-19 vaccine clinic for students ages 5-11 in our school district. Westchester County is asking for data to determine the level of parent interest in providing an on-site clinic in Harrison. Please complete this brief survey to indicate your interest.

If Harrison is selected to offer an on-site vaccine clinic, parents will receive more information about the details.
Parent/Guardian Name*

First NameLast Name
Email Address*
example@example.com
How many children (ages 5-11) in your household would you schedule to receive the COVID-19 vaccine if a vaccine clinic can be offered in Harrison schools?*

123456
Should be Empty:

Harrison Central School District