COVID Vaccine Clinic Info & Consent FormsDear Parents/Guardians,
If you signed your child up to receive the Pfizer/BioNTech vaccine, please read the information below.
In order for your child to receive the vaccine, you must fill out the appropriate parent/guardian vaccine consent and screening forms below for each child that will be receiving the vaccine.
All completed forms must be signed and returned to your child’s school on or before Thursday, May 20, 2021.
We apologize for the quick turnaround, but the Cayuga County Health Department needs the consent forms in order to order the appropriate amount of vaccines.
Consent forms for students at Auburn High School, Genesee Elementary, Owasco Elementary, and Seward Elementary:
East Hill Family Medical - COVID Immunization Screening and Consent Form
The vaccine clinic for students ages 12 and older who attend Auburn Junior High School, Casey Park Elementary, and Herman Ave Elementary will be conducted by the Cayuga County Health Department at Auburn Junior High School on Wednesday, May 26, 2021 from 12:00 to 1:30 p.m. The Auburn Enlarged City School District will be providing transportation to and from Auburn Junior High School for students who attend Casey Park Elementary and Herman Ave Elementary.
Consent forms for students at Auburn Junior High School, Casey Park Elementary, and Herman Ave Elementary (must complete BOTH forms):
Cayuga County Health Department - Pfizer Minor Consent Form
Cayuga County Health Department - Pfizer Vaccine Screening Form
Please note, one parent or guardian will be permitted to accompany your child to the clinic if desired.
A second vaccine clinic to administer second doses has been scheduled for Wednesday, June 16 from 12:00 to 1:30 p.m. Only one consent form is required to cover both doses of the vaccine, but you will need to complete another screening form for the second dose.
In addition, please find a Fact Sheet for recipients and caregivers of the Pfizer/BioNTech COVID-19 vaccine here: Pfizer-BioNTech COVID-19 Vaccine EUA Fact Sheet for Recipients and Caregivers
If you have any additional questions, please contact your child’s school nurse, the Cayuga County Health Department at (315) 253-1560 (AJHS, Casey, Herman), or East Hill Family Medical at (315) 253-8477, Prompt 9, Extension 407 (AHS, Genesee, Owasco, Seward).