Flu Screening Form

PROTECT YOURSELF AND THE ONES YOU LOVE WITH A 

Free Flu Vaccine

FROM THE 

PASADENA PUBLIC HEALTH DEPARTMENT

Wednesday, October 28 and Thursday, October 29

9:00 AM - 1:00 PM 

John Muir High School

1905 Lincoln Ave.

Wednesday, November 4 and Thursday, November 5

9:00 AM - 1:00 PM

Pasadena High School

2925 E. Sierra Madre Ave. 

*This is not a COVID-19 test or vaccine

*Vaccines are available to anyone ages 6 months and older

*Children under the age of 18 must have a guardian present 

*Anyone feeling ill should not attend

*All vaccine recipient information is submitted to the California Immunization 

*Registry (CAIR) (Learn more at http://www.CAIRweb.org)

* Please wear a short-sleeved shirt and a cloth face covering 

*Physical distancing will be observed at all times

The Pasadena Public Health Department often photographs or videotapes programs for use in publicity materials. By being present during these activities, you consent to the use of your appearance or likeness by the Department, and its licensees, designers, or assignees, in all media, worldwide, in perpetuity. To ensure the privacy of individuals and children, images will not be identified using names or personal identifying information without written approval from the photographed subject, parent, or legal guardian.