Roman Catholic Archdiocese of Palo
RCAP Clergy COVID-19 Vaccination Survey
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RCAP Clergy COVID-19 Vaccination Survey
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Name
*
First
Last
Parish Assignment
*
Position/Office
*
Have I been Vaccinated with any of the COVID-19 Vaccines?
*
YES
NOT YET
WHERE were you Vaccinated?
*
Municipality of my Parish Assignment
Municipality of my Place of Residence
Other
If YES,
*
First Dose
Second Dose (complete)
The Vaccine requires 1 dose only
What kind of COVID-19 Vaccine was administered to you?
*
PFizer
AstraZeneca
Sinovac
SputnikV
Johnson&Johnson’s
Bharat BioTech
Moderna
Sinopharm
If NOT YET
*
I AM willing to be vaccinated
I AM NOT willing to be vaccinated
Submit
