Mothers of Hope in partnership with the Family Health Center host this community based walk up vaccine clinic to ensure access for the most vulnerable residents. Please pick a time below to schedule your appointment and meet us on Kalamazoo’s Eastside, at Thirteen & 1\2 Party store, 806 Riverview Drive. This effort is designed to address the health disparities of people in the neighborhood which have been more exasperated by the COVID-19 pandemic.
2019-Covid Vaccinations Registration Form
Mothers of Hope - 13 1/2 Party Store - 806 Riverview Drive, Kalamazoo, MI-May 7, 2021 (3:00pm-6:00pm)
Name
First Name
Last Name
Email
example@example.com
Date Of Birth
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Race Category
Asian or Pacific Island
Black
Bi-or Multi Racial
Native American/Alaskan Native
White
Gender
Female
Male
Trans-Female
Trans-Male
Genderqueer/Gender Non-Conforming
Appointment
Submit
Should be Empty: