Vaccine Volunteers IL - BOOSTER COVID Vaccine Scheduling Assistance
BOOSTER SHOTS ARE NOW AVAILABLE FOR ALL INDIVIDUALS 16+

TO RECEIVE ASSISTANCE SCHEDULING A BOOSTER VACCINE, PLEASE SUBMIT THIS FORM

WE CAN ASSIST INDIVIDUALS IN ANY US STATE!

Submission of this form does not guarantee a COVID-19 vaccine appointment.

You should never be asked for any part of your SSN or any passwords. If you are, please immediately discontinue contact with the volunteer and report it to the contact information below.

Please review our privacy policy at https://www.vaccinevolunteersil.com/privacy-policy

Vaccine Volunteers IL was created by Avi Rubin, a high school student in Highland Park who has helped connect COVID-19 vaccine appointments to thousands of individuals.

Our team: Avi, Jamie (JME), Erica, Susan

For form assistance, email VaccineVolunteersIL@gmail.com or text ‪(312) 210-0311‬
Sign in to Google to save your progress. Learn more
Email *
Whose information are you entering? *
YOUR First Name *
This field is for people submitting on behalf of others. If you are submitting for yourself, please fill this field out and the one below both with your first name.
First Name *
Last Name *
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy