Monmouth County Regional Health Commission

The Monmouth County Health Commission No.1


WHERE: Red Bank Regional High School
101 Ridge Road, Little Silver, NJ 07739
WHEN: Saturday, June 5th, 2021
9 am to 2 pm


  • One form must be filled out for each individual wishing a vaccine.
  • Appointments will be made on a first come first serve basis upon receipt of completed form.
  • This clinic will use the Pfizer-BioNTech vaccine only which is approved by the US Food and Drug Administration (FDA) to vaccinate individuals aged 12 and older.
  • Second doses will be available on June 26, 2021.
  • Parents or guardians should accompany minors OR a signed Vaccine Administration Record (VAR) must be provided.
  • Clinics held in conjunction with Walgreens and Red Bank Regional High School.
  • Registration ends June 3, 2021.
  • Please bring your insurance card.

To register fill out and return one of the below Patient Registration forms to:
telephone: 732-493-9520 #1 multilingual staff available
fax: 732-493-9521

Additional COVID-19 vaccine information can be found at:
New Jersey Department of Health

Please click here to download a PDF of this flyer.

Please click here to download the Patient Registration Form in English.
Please click here to download the Patient Registration Form in Spanish.