Below you will find the COVID - 19 Vaccine Form that must be completed for your child to receive the Pfizer COVID vaccine. Please complete this form and either email it to our school nurse, Amber Farnsworth  afarnsworth@mariettacsdoh.org  or have your child bring the signed form to the school office no later than this Friday afternoon. The first shot will be administered Monday November 15, at your child's school. We must have the signed consent form for your child to receive the vaccine. The form must be signed by the custodial parent. 

The second shot will be given on December 6, at your child's school. You will have to sign a second consent form to receive the second shot.


COVID VACCINE CONSENT FORM