5-11 year old Parent Vaccine Interest Survey

Public Health is partnering with our local healthcare systems to assist in the vaccination of our communities. Children ages 5+ will soon be eligible to receive the Pfizer vaccine. Your input will help us to plan vaccinating this population. Thank you!

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* 1. Are you planning to get your 5+ year old vaccinated?

Yes

Not sure

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* 2. What school does your child attend?

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* 3. Do you have more than 1 child 5 and older who you want to get vaccinated?

Yes

How many over 12?

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* 4. With your permission only, how would you prefer your student to be vaccinated?

During the school day, with parent present

At an onsite school clinic, after the school day

Through your healthcare provider

Through the community: Local Public Health, Pharmacy, Hy-Vee ect.

5-11 year old Parent Vaccine Interest Survey

Question Title

* 1. Are you planning to get your 5+ year old vaccinated?

Question Title

* 2. What school does your child attend?

Question Title

* 3. Do you have more than 1 child 5 and older who you want to get vaccinated?

Question Title

* 4. With your permission only, how would you prefer your student to be vaccinated?

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* 5. Thank you for your input, this will greatly help our planning process. Please click the "Done" button so your response is recorded.