HNJH COVID-19 Vaccine Sign-Up

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HNJH will be hosting COVID-19 vaccine clinics for area residents aged 65+. Please fill out the information below to put your name on our lists, and a team member will call you back to schedule your vaccine appointment. After the vaccine is administered, you will be asked to wait 15 minutes for symptom monitoring. Keep in mind that you will need a second dose.

We are currently vaccinating healthcare workers in Phase 1A, seniors aged 65+ and some essential workers (first responders, corrections staff, child protective services staff, daycare workers, Educators PreK-12, and education support staff.)

First Name *

Last Name *

Date of Birth *

YYYY

Phone Number (this is the number we will call to schedule your vaccination appointment) *

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