Vaccination Waiting List Registration

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If you are interested in receiving a Covid 19 vaccine and are a resident of Kentucky, please complete the registration form below.  Due to limited supply of vaccine allocated from the state, it may take some time before you receive a call to schedule an appointment to receive the vaccine.  We appreciate your patience as we work through this process.

To be eligible for vaccination, you must meet the age requirement of 18 or older. You may also register for ages 12 -17 if interested.

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Incase of cancellation, can you be at your selected clinic within 30 minutes to receive vaccine?
If you are under age 70, please mark any conditions if applicable

If you selected "other", please list below