RIVERS CASINO - COVID-19 Vaccination Sign Up Sheet
This event is open to all Team Members, your family members (12 years and older) and customers. A parent or guardian must be present for those who are 12-17 years old. You must live or work in the City of Philadelphia to participate.
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Email *
What is your relationship to Rivers Casino - Philadelphia? *
Employee ID Number
Please enter your Employee ID Number if you work for Rivers Casino - Philadelphia. (If not a Team Member please proceed to the next question).
Department
Please enter the name of your Department if you work for Rivers Casino - Philadelphia (If not a Team Member please proceed to the next section).
First Name *
Last Name *
Date of Birth *
MM
/
DD
/
YYYY
Address *
Please enter your mailing address. (including APT#/ UNIT/ Building #, etc.)
City *
Please enter the name of the city in which you reside.
State *
Please enter the name of the state in which you reside.
Zip Code *
Please enter the Zip Code of the city in which you reside.
Telephone Number *
Please enter the best number to contact you. (XXX) XXX-XXXX
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