Waiting list is open to sign-up.

After you sign up, our staff will call you on your selected vaccination date if there is an opening.

Pleasanton Campus

Saturday, April 17th

8:30am to 3:30pm

Milpitas Campus

Sunday, April 18th

8:30am to 3:30pm

Safeway Pharmacy is our service provider. Pfizer vaccine will be used.

What to do Before Your Appointment

IMMUNIZATION CONSENT FORM

YOU MUST COMPLETE THIS FORM TO YOUR APPOINTMENT

Download this COVID-19 Immunization CONSENT FORM (English) to complete and bring with you to your appointment:
https://drive.google.com/file/d/1G5gAn0ATFQApIetcU1m2SYOsLJ8IxyRG/view?usp=sharing

What to Bring to your Appointment:

  • Completed Immunization Consent Form
  • Driver’s License
  • Your Prescription Insurance Card if you have them (including Medicare or supplementary coverage)
  • Insurance is NOT required if you do not have it
  • Please wear a short-sleeve shirt if possible
  • Please DO NOT COME TO YOUR APPOINTMENT if you are feeling unwell or experiencing COVID symptoms!

Dates

  • April 17th, Saturday,  8:30am to 3:30pm at Pleasanton Campus (map)
  • April 18th, Sunday,  8:30am to 3:30pm at Milpitas Campus (map)

Current Eligibility

Everyone at least 18 years old is eligible to get vaccinated.

This is NOT a vaccine waitl form.
這不是

Drop us a line if you have any questions​

This form is for general inquiries and is NOT a vaccine registration form.

(408)586-8688

电子邮件 info@CrosspointChurchSV.org