Alpine ISD Vaccination Event (Pfizer)

Alpine ISD will be hosting a vaccination event on May 18th, 2021 for students 12 years and older. DSHS staff will provide the first dose of the Pfizer vaccination for up to 150 people. This is not required by students but available for those that would like to be vaccinated.

First Dose
Date: Tuesday, May 18th
Time: 2:00 pm
Location: Alpine High School

Second Dose
Date: Monday, June 7th
Time: TBD
Location: TBD

Please contact Gayla Owen, at 432-837-7730, by Friday if you plan on receiving the vaccination. This allows DSHS to bring the proper amount of vaccines to the site.

DSHS staff will arrive at 1:30 pm to review paperwork and vaccinations will start at 2 PM.  Please see the attached English and Spanish educational documents below.

Please ensure that the following paperwork is completed prior to your appointment.

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Paperwork (For client to complete prior to arrival)

1. Pre-Vaccination-Screening Form – English
   (Complete Page 1 - Patient Name, Age, Q1-Q11 only. State Staff will complete “Form Reviewed By” and apply “Date”).

2. Pre-Vaccination-Screening Form – Spanish
   (Complete Page 1 - Patient Name, Age, Q1-Q11 only. State Staff will complete “Form Reviewed By” and apply “Date”).

3. DSHS COVID Client Vaccination Form
   (Section I: Personal Information to be completed by client only).

4. DSHS COVID Client Vaccination Form Dose Two
   (To be completed by those who only need Dose Two; complete up until Section IV: Dose 1 Review only) *Only attach when client is returning for Dose #2 from a previous DSHS COVAX event. If client is new to a DSHS COVAX event, have them complete the entire “DSHS COVID Client Vaccination Form (page 1-2).

5. DSHS General Consent Form.

Paperwork (For client to read and keep).

1. Pfizer-EUA Fact Sheet - English

2. Pfizer-EUA Fact Sheet - Spanish

3. VSafe-English

4. VSafe-Spanish