PLEASE READ EVERYTHING ON THIS PAGE CAREFULLY AND PRINT OUT ALL FORMS BEFORE ARRIVING

Where:
Saint  Joan of Arc Catholic Church
359 West Areba Avenue, Hershey PA
In the Social Hall across from the Church

When:
Saturday, March 27, 2021
10:00 AM to 2:00 PM

Type of Vaccine:  Moderna

​Who is eligible?
           Anyone over 65 years of age or in Category 1A of Pennsylvania Covid Vaccine Rollout is eligible. Please see link below to see a full list of those eligible to receive the vaccine.

What forms do I need?
Please download and fill out the forms at the bottom of the page before you arrive at your appointment.

How do I sign up?
Sign up for a time by calling 717-533-7168 X133 between the hours of 8:00 and Noon and 1:00 and 4:00 PM. 
You must have an appointment to receive the vaccine.
 
(Please arrive fifteen minutes before your appointment and expect to remain onsite for at least fifteen minutes after you receive your shot. A special Thank-You to Hershey Pharmacy for providing this service!)

Link to PA Vaccine Eligibility Website

Below are 6 forms that must be printed out and brought with you to your appointment. Please fill out the Pre-Vaccination Questionnaire, Health Insurance Form, and Consent to Immunization before arriving at your appointment.

DOCUMENTATION CHECKLIST

HEALTH INSURANCE FORM

MODERNA VACCINE FACT SHEET

Consent to Immunization

Pre-Vaccination Questionnaire

Form for the Pharmacist