Town of Bedford Vaccine Registration
 New Vaccination Site Will Be Opening on Monday, April 12th

In partnership with the Antioch Baptist Church, the Town of Bedford will be opening a vaccine pop-up site at the Bedford Town Hall (321 Bedford Rd. Bedford Hills, NY 10507).

The vaccine being administered will be Johnson & Johnson's Janssen COVID-19 Vaccine (one dose only).

To register, please fill out the necessary information in

Only those aged 18+ will be eligible at this time. You must bring proof of ID to your appointment!
Sign in to Google to save your progress. Learn more
Name *
Phone Number (include area code, no spaces or dashes) *
E-Mail *
Date of Birth (MM/DD/YYYY) *
Address (Street, Town, Zip Code) *
*
Captionless Image
Required
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report