COVID-19 Vaccination Interest
This form will be used to sign Transportation employees up for their first round of the COVID vaccination, beginning Monday 2/8/2021.
Email address *
Name (First, Last) *
Date of Birth *
MM
/
DD
/
YYYY
Gender *
Ethnic Background *
Phone Number *
Street Address *
Zip Code *
City *
Best Day and Time for Vaccination
You will need at least an hour window to receive your vaccination. This includes a sit time of 20-30 minutes after you receive the vaccination to ensure your are free from immediate adverse reactions.
Best Day(s) - Choose all that apply *
Required
Best Time(s) *
Submit
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