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COVID-19 Update
SUNDAY WORSHIP
Pastor & Wife Appreciation
Covid Vaccine/Booster

HOME
WHO WE ARE
MEDIA
MINISTRY OF GIVING
- Donate
FORMS
COVID-19 Update
SUNDAY WORSHIP
Pastor & Wife Appreciation
Covid Vaccine/Booster

SUNDAY WORSHIP

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COVID VACCINE FORM

COVID 19 VACCINATION/BOOSTER

LA County Department of Public Health will be administering Pfizer COVID 19 vaccine and booster shots at Faith Hope and Love on Thursday, October 6th from 2 PM to 5 PM. Interested members and friends must complete the form so that we can provide a head count. Heath Insurance is required. To determine eligibility, you must bring your COVID vacination card and picture ID.

Hi there!

1st Booster Shot

Moderna

Johnson & Johnson

Ages 5-17

2nd Booster

Your Information

Name1 *

First

Last

Type Vaccine1

Pfizer Infants: Ages 6 mo - 4 Years
Pfizer Pediatrics: Ages 5 - 11 Years
Pfizer Adult: Ages 12 and above
Bivalent booster: Pfizer recommends the Bivalent booster for anyone 12 and over. This vaccine combats the original coronavirus strain as well as the Omicron variant.
Novavax for anyone 12 and over who hasn't received any doses of the covid vaccine.
Flu shot

Select Time

2 PM
2:30 PM
3 PM
3:30 PM
4 PM
4:30 PM

Is someone else being vaccinated or receiving the booster shot?

Name2 *

First

Last

Type Vaccine2

Pfizer Infants: Ages 6 mo - 4 Years
Pfizer Pediatrics: Ages 5 - 11 Years
Pfizer Adult: Ages 12 and above
Bivalent booster: Pfizer recommends the Bivalent booster for anyone 12 and over. This vaccine combats the original coronavirus strain as well as the Omicron variant.
Novavax for anyone 12 and over who hasn't received any doses of the covid vaccine.
Flu shot

Select Time (copy)

2 PM
2:30 PM
3 PM
3:30 PM
4 PM
4:30 PM

Is someone else being vaccinated or receiving the booster shot2?

Name 3 *

First

Last

Type Vaccine3

Pfizer Infants: Ages 6 mo - 4 Years
Pfizer Pediatrics: Ages 5 - 11 Years
Pfizer Adult: Ages 12 and above
Bivalent booster: Pfizer recommends the Bivalent booster for anyone 12 and over. This vaccine combats the original coronavirus strain as well as the Omicron variant.
Novavax for anyone 12 and over who hasn't received any doses of the covid vaccine.
Flu shot

Select Time3

2 PM
2:30 PM
3 PM
3:30 PM
4 PM
4:30 PM

Email *

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