To sign up for the COVID-19 Vaccine waitlist, please complete the form below and we will contact you as soon as vaccines are available. Thank you.


Are you a healthcare employee or professional (Do you work in one of the following: hospital, long-term care facilities, outpatient clinic, home health care, pharmacy, emergency medical service, or public health)?
Are you a resident of a long-term care facility (skilled nursing facility, assisted living facility, or other residential care)?
Are you an essential worker (Do you work in education, food & agriculture, utilities, police, firefighter, corrections officer, or transportation)?
Do you have a high-risk medical condition (i.e. cancer, chronic kidney disease, COPD, diabetes, heart conditions such as heart failure, coronary artery disease, or cardiomyopathies, obesity (BMI > 30 kg/m2), pregnancy, sickle cell disease, and/or smoking)

Thanks for submitting!

Please fill out documents and bring them with you to your vaccine appointment. Appointments will be made as more vaccine doses are received. Thank you.

Consent Form:

Formulario de consentimiento:

Pre-Vaccination Checklist:

Lista de verificaciones: