Event Sign Up Sheet | Track It Forward

Second Round of School-Age Vaccinations

Thursday, September 15 2022

Date of Appointment: 09/15/22

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

Pickup Address: 1946A Shadybrook Drive, Beford, TX 76021

Facility and Doctor Name/Adress: Pediatric Mobile Clinic

Address: JP Elder Middle School, 709 NW 21st, Fort Worth, TX 76164

Documents Needed: Picture ID, Previous Vaccination Records

Estimated time of entire appointment: 1-1:30 hrs

Full Client Name (s), Gender and Birthday: Setaish Azizi (Female, 06/25/2015), Mohammad Azizi (Male, 06/28/2013), Mohammad Qasim Azizi (Male, 11/29/2017)

How Many Adults/Children:

2. One Parent and three children

Case Worker name and number for volunteer questions:

Stuart Robinson 682-325-9855

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