COVID-19 Vaccination Waitlist Registration


Fields marked * are required

















Your email provides an additional way for us to contact you if we are unable to reach you by phone. We only ask for your email and phone number to send reminders or to contact you about getting vaccinated. Your information will not be used for any other purpose. Thank you!


Male   Female



   
We only ask for your gender and birth date in order to meet reporting requirements for the Illinois Department of Public Health (IDPH). Your information will not be used for any other purpose. Thank you!



Yes   No


Healthcare personnel or resident of a long-term care facility
Age 65+
Essential worker*
Age 16-64 with medical conditions that increase the risk of severe COVID-19
Age 16 and Older**

*Firefighters, police officers, corrections officers, food and agricultural workers, United States Postal Service workers, manufacturing workers, grocery store workers, public transit workers, those who work in the educational sector (teachers, support staff and daycare workers), higher education staff, government workers, news media, restaurant workers, construction trade workers, and religious leaders
**Pfizer vaccine is currently the only vaccine approved for those age 16-17; we will only make appointments for this age group when we know we will be receiving the Pfizer vaccine for specific event dates.