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Holliston H1N1 Vaccination Clinic
Pre-registration Form

Clinic DateSaturday, February 6, 2010
Clinic Time
12:00 pm - 2:00 pm
Clinic LocationSt. Mary's Church Hall
8 Church Street
Holliston, MA
TargetHolliston BOH is sponsoring a H1N1 clinic open to all 3 years old and over. Everyone is required to register here and bring your printout with you. If you are assigned an appointment time that is inconvenient for you, please come anytime between noon and 2:00 p.m. on February 6th. The clinic will be held at St. Mary's Church Hall, 8 Church Street, Holliston between 12PM and 2PM

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
 
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If under 18: Name of parent or legal guardian of person being vaccinated