H1N1 Clinic Registration

H1N1 Swine Flu Registration Form

Registration does not guarantee that you will receive a vaccination
or there will be vaccine available. Vaccinations are available for ALL Individuals

If your child has turned 10 since the first vaccination, there is not need to obtain a second vaccination.

There are No Clinics Currently Scheduled Please contact the Health Department for Additional Information

NOTE: The Washington Township Health Department is providing vaccinations to the general population. There are no restrictions to obtaining the vaccination. Please be advised that the H1N1 vaccine, currently available to Washington Township, contains thimerosal, a mercury-based preservative that has been used for decades in the United States in multi-dose vials (vials containing more than one dose) of some vaccines to prevent the growth of microorganisms. Please download the Informative file on 'General Questions and Answers on Thimerosal'. 27Kb
First Name
Last Name
E-Mail
Address
City
State
DOB
	I have downloaded, (37Kb) read and understand the information contained on the 2009 H1N1 Influenza Inactivated Vaccine Need to Know document.	I have downloaded (28Kb) printed, and completed the Morris County 2009-10 H1N1 Injectable Vaccine Consent Form, and will bring the form to the clinic. I understand that I will not receive the vaccination without completion and submittal of the consent form.

CLINICS ARE SUBJECT TO CANCELLATION OR CHANGE ACCORDING TO VACCINE AVAILABILITY. PLEASE CHECK HERE FREQUENTLY AT

Please contact the Health Department at 908-876-3650 for additional information.