Covid-19 Vaccination Consent Form for 12-15 year olds

We are now offering the Comirnaty (Pfizer/BioNTech) Covid-19 Vaccine in Rosscarbery Pharmacy. 

If you are between the ages of 12 and 15 or over 16 and have NOT yet received a COVID-19 vaccine, please contact us by phone (083-4397126) to be added to our waiting list. 

ONCE YOU HAVE AN APPOINTMENT CONFIRMED BY A MEMBER OF STAFF, you can fill out the below consent form. This form only applies for the 12-15 year old category. There is a separate form for over 16's. Please do not fill out the form unless you have a confirmed appointment as this will be null and void.

Before you fill out the consent form you must read:

 

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