November 5, 2021

Good afternoon,

Yarmouth Elementary School will be holding a COVID Pfizer vaccination clinic on 11/23/21, with second doses administered on 12/21/21.  We will be partnering with Northern Light Home Care & Hospice to provide this clinic to our students.  

If you are interested in having your child vaccinated, please click on the link below and complete the consent form by Monday 11/22/21 at noon.  You must type something into all highlighted fields, so please use NA if it doesn’t apply. Although the vaccine is provided at no charge, there is a cost to administer the vaccine. We appreciate it if you include accurate insurance information. Children presenting with an incomplete form will not receive their vaccine. There is no out-of-pocket cost and those without insurance will be vaccinated with the appropriate form completed.

Yarmouth Elementary School COVID vaccine consent

  • You will be notified if there is a change in the planned dates of school COVID clinics.
  • You will not receive a confirmation email. If you get to the end of the form, it is complete. 
  • The Vaccine Safety Sheets will be sent to your email. Please take a minute to read these. They are also included as an attachment. Vaccine Information Fact Sheet
  • If you need a translated form or are unable to complete an electronic form, please let the school nurse know and we will send a paper form home. We have also included it as an attachment. COVID Vaccine Consent Form

This clinic is only for students aged 5-11.  We cannot vaccinate students who are older than 11. **If your child turns 12 before the 2nd clinic, please plan for them to get the 2nd dose at your PCP office. They will require a different vaccine than the 5-11 year-olds. 

For questions about the vaccine clinics at our school, please contact the YES school nurse, Alison Thomson, at


Ryan Gleason, YES Principal & Molly Kilpatrick, YES Assistant Principal