Event Sign Up Sheet | Track It Forward

School Age Vaccinations

Tuesday, August 30 2022

Date of Appointment: 08/30/22

Appointment Time: 9-2pm (specific time unknown)

Pickup Address: 3517 Terra Trail #6101

Facility and Doctor Name/Adress: Pediatric Mobile Clinic,

Richard Wilson Elementary (Blue Bus) 900 West Fogg Street, Fort Worth, TX 76110

Documents Needed: Picture ID, Previous Vaccination Records

Estimated time of entire appointment: 1 hour

Full Client Name (s), Gender and Birthday: Sangwa, Raymond Male, 4 years old.

How Many Adults/Children:

2. One Parent and one child

Case Worker name and number for volunteer questions:

Stuart Robinson 682-325-9855

Volunteer Notes from the appointment:

Client had previously been to clinic. The school said he was missing a vaccination and will not be able to return to school until he has been fully vaccinated.

9:00am - 2:00pm

Contact the event organizers: