WPS Student Vaccination Sign Up
Wayzata Public Schools will be conducting the following COVID-19 vaccination clinics:

Wayzata High School (Gymnasium 9 Note: If you are coming from outside of WHS, please park in the back bus loop and enter through the Lower Commons Doors)
WHS First Vaccine Dose Clinic
Wednesday, May 19
9 a.m. - 1 p.m.

Central Middle School (Maintenance Building, follow signs once entering parking lot)
CMS First Vaccine Dose Clinic
Thursday, May 20
2 - 6 p.m.

We will prioritize students ages 12 and older, but the event is also open for parents and staff (See separate forms in email). Please use this form to sign up for a Pfizer vaccine at one of these clinics.

Please complete this Google form and one consent form (https://bit.ly/3ybE8H4) for EACH student wishing to be vaccinated.

Students younger than age 18 must have a signed parent consent form with them at the time of vaccination. Please print and sign this form and send it with your student on the day of the vaccination.
Sign in to Google to save your progress. Learn more
Enter your Email Address *
Please indicate which vaccine clinic you wish to attend: *
Student Grade *
Student Date of Birth *
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Student First Name (Must be age 12 or older): *
Student Last Name (Must be age 12 or older): *
Which school does your student attend? *
Parent or Guardian Name: *
Home Phone Number: *
For Central Middle School Families Only
Central Middle School parents may choose to have your student vaccinated from 2-3:30 p.m. on Thursday, May 20 and have your student ride the bus home. Students must bring a signed parent consent form with them in order to be vaccinated. Please indicate below that you would like your student vaccinated from 2-3:30 p.m. on May 20.
CMS Student Vaccines May 20 from 2-4 p.m.
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Student Name
For East and West Middle School Families Only
A shuttle bus will be provided at 4 p.m. on Thursday, May 20 for East Middle School and West Middle School students who would like one-way transportation to Central Middle School. Parents/guardians will be responsible for picking up their student no later than 5 p.m., after they have received their vaccination.
Would you like your middle school student to take a shuttle bus to Central Middle School?
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Student Name
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