Second-Dose Vaccination Event (Pfizer)

Administration

Alpine ISD will be hosting a vaccination event on June 7, 2021 for students 12 years and older.  DSHS staff will provide the second 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.  The first dose was given on Tuesday, May 18th, 2021.

Second Dose
Date: Monday, June 7th
Time: 2:00 – 4:00 p.m.
Location: Alpine Elementary Cafeteria

Please contact Gayla Owen, at 432-837-7730 or by email gowen@alpineisd.net  if you have any questions or plan on receiving the vaccination and this is your FIRST dose.  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.

Please note:  If this is your second vaccine, please only print and complete page 2 on the DSHS Covid Client Vaccination form.

PLEASE BRING YOU VACCINE CARD WITH YOU SO THE SECOND DOSE CAN BE DOCUMENTED.  

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

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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