Flu Shot Sign-up for November 9 (Himel)

Flu Shot Sign-up for November 9
Please complete this form to select your preferred time to attend the flu shot clinic on Tuesday, November 9th, 2021, between 1:30 and 2:30.

The doctor will be set up at Himel East.

If possible, please try to schedule your appointment during a time when you are not in the classroom.

This form is for Himel (East and West) staff only.
Name*

First NameLast Name
Email*
example@example.com
Date of birth*

MonthDayYear
Date
Do you require classroom coverage?*

YesNo
Time*
Should be Empty: