Region 4A
Public Health Emergency Response
Massachusetts fastest growing Medical Reserve Corps

 

MRC
 

Town of Hopkinton H1N1 Vaccination Clinic
Pre-registration Form

Clinic DateSaturday, January 23, 2010
Clinic Time
12:00 pm - 4:00 pm
Clinic LocationHopkinton Middle School
88 Hayden Rowe
Hopkinton, MA
TargetThe Town of Hopkinton is sponsoring a H1N1 clinic for all Hopkinton residents

*The snow date for the clinic is 01/30/2010.

The Board of Health will be offering vaccinations against the Flu virus at the above date and time.

To register for this clinic, please answer the questions below regarding the person to be vaccinated.

Name of person being vaccinated
 
Yes
No
 
View
 
 
 
 
If under 18: Name of parent or legal guardian of person being vaccinated