K-8 Vaccination Status

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Dear Parents,
Below is a simple survey to help us understand the percentage of our students who are vaccinated K-8. This information will remain confidential and will be used to help us make decisions regarding our mitigation strategies. Please fill in a survey for each of your children that attend Saklan.

Student's First Name *

Student's Last Name *

Grade Level *

Kindergarten

First Grade

Second Grade

Third Grade

Fourth Grade

Fifth Grade

Sixth Grade

Seventh Grade

Eighth Grade

Vaccination Status *

My student is fully vaccinated.

I plan on vaccinating my student, but will be waiting a little longer

My student will not be vaccinated this year.

Other:

Comments or Questions

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of The Saklan School. Report Abuse

Forms