Please complete this vaccine interest form to be placed on our Covid-19 Vaccination waitlist. Completing this form does not guarantee a vaccination.
When we have a supply of vaccine we will email you a link to schedule an appointment
A new submission needs to be completed for each individual family member. Currently the vaccine we have on hand is only approved for ages 16 and older. Please make sure to fill out the entire form until you get to the last page that says Thank You! You should also receive an email confirmation from Jotform.