Vaccine Sign-Up Form - Ada S. McKinley

Register Here to receive the COVID-19 vaccine at Ada S. McKinley’s Vaccination Clinic on Saturday, June 5, 2021 from 9:00 am – 1:00 pm at 6033 S. Wentworth in Chicago. You will hear back from someone shortly regarding your appointment time. This clinic will be administering the Pfizer vaccine. The second dosage date will be on Saturday, June 26th (same location).

Registration Deadline: Extended to Friday, June 4, 2021

Information provided will only be used for the purpose of the vaccine.

Vaccine Clinic Sign Up Form

Full Name*
First Name Last Name
Referred By
Phone Number*
Email Address*
Address*
Street Address Address Line 2 City State ZIP Code
Date of Birth*
MM slash DD slash YYYY