COVID-19 vaccination and information
Sign up to be notified when it’s your turn to schedule your COVID vaccination
Required consent form and vaccine information forms
COVID information from the Centers for Disease Control and Prevention
Currently, 2 vaccines are used in the US: the Pfizer and the Moderna vaccines.
Which one we will administer on any given day depends on what supply we’ve been provided. Therefore we can’t tell you ahead of time which vaccine you will get. Nor can we accommodate individual preferences for the first dose.
Both vaccines require 2 doses to be fully effective. When you come in to receive your first dose, we’ll schedule your follow-up appointment for the second dose at that time and ensure that you get the correct vaccine for the second dose.
Please download, print and fill out this form and then bring it with you when you come in for your vaccination.
The consent form asks you to verify that you have read and understand the data sheets for the COVID-19 vaccine.
Depending on what we have available and are dispensing on the particular day that you are scheduled for your vaccination, you will receive either the Pfizer or Moderna vaccine. Therefore we ask you to read the data sheets for both vaccines:
Signing up here will ensure you are notified when we have the COVID-19 vaccine available for your group.
At that time you will be contacted by email and provided a link to schedule your vaccination appointment.
We may also send a text message to the phone number you enter on this form, or call you at that number to schedule your vaccination.
Because we only have limited vaccine availability, you must have an appointment to receive the vaccine.
If your receive the vaccine elsewhere or your group status changes, it is important that you notify us immediately at firstname.lastname@example.org or 501-223-2636.
We’ll also email you periodic updates on the vaccination process.
Please note that each person must sign up individually.
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