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Friday, April 2nd

9am - 1pm

Complete the form below to Pre-Register for your vaccination. Vaccinations will be given at: The Word Center 5305 Executive Place Jackson, MS

Moderna Vaccination Registration

To register, please take the time to fill out the information below.

Are you over 18 years of age?
Do you have a history of severe allergic reactions (e.g., anaphylaxis*), including from any prior injectable medications or vaccines? Yes or No *anaphylaxis-a severe allergic reaction that leads to wheezing, chest tightness, difficulty breathing, rash, swelling in throat and lowered blood pressure that starts between 5-30 minutes after contact with an allergen
Have you received any other vaccine within the past two weeks?
Are you pregnant, breastfeeding, or immunocompromised?
Have you recently been exposed to a person with COVID-19 within the last 14 days, or are you currently under quarantine for exposure?
Have you received monoclonal or antibody therapy for COVID-19 in the previous 90 days?
Have you recently or previously tested positive for COVID-19?
We are administering the first does of Moderna. Please click to confirm that this is your first dose
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