Requesting a COVID-19 vaccination for 5-11 year olds living with someone who is immunosuppressed in North Wales.

1. Introduction

Following extensive assessment of the risks and benefits of vaccinations for 5 to 11 year olds, the JCVI has updated its advice for this age group. Children aged 5 to 11 who are living with someone (of any age) who is immunosuppressed, should be offered a primary course of COVID-19 vaccination. If you are a parent or guardian of a child living in North Wales who fits into the above age group and criteria, please fill in the following form to request a COVID-19 vaccination for the child.

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Full name of parent/ guardian requesting for the child to be vaccinated

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Parent/ Guardian's telephone number

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Full name of at least one person who is immunosuppressed and living in the same household as the child.

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Following on from the previous question - date of birth of the immunosuppressed person living with the child:

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Full name of the 5-11 year old child

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Date of birth of the 5-11 year old child

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Address of the 5-11 year old child

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