Special Olympics COVID-19 Vaccine Interest Form
Please fill out the form below with the main contact for your family. Upon completing the form, you will receive an email to schedule you and your family. Link: https://covidvaccine.nj.gov
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
How many family members will receive the vaccine?
*
You will receive an email to schedule your appointment shortly. Please remember to register on NJ Vaccine Scheduling System here: http://covidvaccine.nj.gov
Submit
Should be Empty: