COVID-19 Vaccine Ages 5 - 11

The City plans to start administering Pfizer vaccines for 5-11 year olds in the upcoming weeks. The Illinois Department of Public Health (IDPH) and the Evanston Health and Human Services Department (EHHS) adopted the Centers for Disease Control and Prevention’s (CDC) recommendation for children ages 5 through 11 years to receive the Pfizer-BioNTech COVID-19 vaccine.

The Pfizer-BioNTech COVID-19 vaccine is administered as a series of two doses, 3 weeks apart, for all eligible individuals. EHHS encourage parents who may have questions about COVID-19 vaccines for their children to talk with their pediatricians or family doctors.

This survey is HIPAA compliant, meaning your health information is protected.

Question Title

* 1. Contact Information

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

Question Title

* 2. Child's School

Question Title

* 3. Child's date of birth

Date