Hayden's Pharmacy

Family Owned and Serving the Youngwood and Surrounding Areas Since 1992

Hayden’s Pharmacy –

COVID-19 VACCINATION  PROGRAM

Children 5-11  – Pediatric Dose

PLEASE READ AND COMPLETE THE FOLLOWING: 

COVID-19 Appointment (ages 5-111 only)
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BEFORE WE START THE REGISTRATION PROCESS FOR THE COVID-19 VACCINE REGISTRATION:

THIS REGISTRATION LINK IS FOR CHILDREN THE AGES OF 5-11 AND CHILDREN AGES 12-18 ONLY!

By continuing, you agree:

1) You are the PARENT or LEGAL GUARDIAN representing the enrolled child to be present at the immunization clinic

2) The PARENT or LEGAL GUARDIAN of a minor patient 5-11 years old or older.

• You nor the enrolled child are not experiencing severe symptoms such as severe shortness of breath, continuous pain or pressure in the chest, or persistent fever greater than 102ºF. If you or the enrolled child are experiencing severe symptoms, please seek medical attention immediately.

• You acknowledge that your or the minor patient’s information will be used as described in the Hayden’s Pharmacy Notice of Privacy Practices.

• You acknowledge as the PARENT or LEGAL GUARDIAN that any portion of the vaccination administration service cost not paid by your insurance or any other federal or state program will be your responsibility. Payment may be due at the time of the test or patients may be billed after the test is performed.

• You agree to receive email communications that contain information about your or the minor patient’s eligibility for COVID-19 vaccination and COVID-19 vaccination future administration appointments.

By selecting "I agree" below, you also have read and accept Hayden’s Pharmacy Clinical Service. *