Vaccination Sign Up Form
‌(Phase 1B)

·         All Adults aged 75 and older

·         First responders

·         Correctional officers and other workers serving people in congregate care settings not included in Phase 1A

·         Food and agricultural workers

·         U.S. Postal Service workers

·         Manufacturing workers

·         Grocery store workers

·         Education workers

·         Clergy and other essential support for houses of worship

·         Public transit workers

·         Individuals caring for children or adults in early childhood and adult day programs

*These categories are general groups. For a more granular list of eligible positions please consult the DOH vaccine plan found here:

*Additional vaccine guidance can be found at the Department of Health's website here:

Vaccination Sign Up Form for Individual

          **Each individual pre-registering for a vaccination requires a separate form and must have their own e-mail address.**