Covid Vaccine Registration Form

Covid Vaccine Registration Form

Thursday November 6th — 10:00am to 2:00pm

Disclaimer:

Thank you for voluntarily supplying your name, email & phone number. This data is retained for the sole purpose of your Pop-Up Program Registration. The BHCC will take every precaution to protect your privacy. Your information will never be shared. By submitting this application you understand & accept the Disclaimer and consent to the BHCC contacting you if we require further information.

 

Please do not forget to bring your Health Card and reading glasses (if required). You will have to fill out a form before getting your vaccine.