SALAMANCA COMMUNITY!
SALAMANCA SCHOOL DISTRICT VACCINE CLINIC
• Date: Monday May 24th, 2021
• Location: Salamanca High School Gym
• Time: Public 2:30 PM – 4:00 PM
WHO IS CURRENTLY ELIGIBLE
• Any individual who lives, works, or study’s in New York State that is 16 years of age and older. The only COVID-19 vaccine that has emergency-use authorization for 16 and 17 years olds is the Pfizer
Vaccine.
CONSENT, REGISTRATION, and SCHEDULE YOUR APPOINTMENT
• Any minor 16 to 17 years of age seeking vaccination must have consent from a parent/legal guardian. Consent must be in writing and must include the name and date of birth of the child, the name and signature of the parent/guardian, and the name of the designee.
• Any individual 18 years of age does not require parental consent to receive the vaccination.
1. Complete Consent and Registration
• If a parent/guardian wishes to provide written consent for the child to receive the vaccination, but does not wish to attend the vaccination clinic with the child, they may utilize the link below to register your child during school hours.
• If a parent/guardian does not wish to provide written consent, but wishes to attend the vaccination clinic with the child and provide consent at the time of vaccination please utilize the link provided below to register your child after school hours. Any parent or family member wishing to register for the vaccine clinic may utilize the link below to register.
https://apps2.health.ny.gov/doh2/applinks/cdmspr/2/counties?DateID=C1BF3D8C56320256E0530A6C7C15FEDE
2. After you complete the registration, you must print a copy of the CDMS registration ticket and bring a copy with you to your scheduled appointment. The registration ticket will also be available in your email.
3. Complete the NYS COVID-19 Vaccine form and bring a copy of the confirmation with you to your appointment.
• https://forms.ny.gov/s3/vaccine
4. Plan to attend your scheduled appointment on time with the following documents:
• Proof of eligibility is REQUIRED. (Any person arriving for vaccination who does not have proof of their identity will not be vaccinated.)
o Proof of eligibility includes driver’s license, learners permit, birth certificate, paystub, school ID.
• A copy of your CDMS Registration ticket/appointment confirmation/registration receipt (from Step 2).
• A copy of the confirmation from the NYS COVID-19 vaccine form from (from Step 3).