Last-minute Vaccine Interest Form

Please fill this out if all of the following are true:

• You are currently eligible (65+, healthcare workers who provide direct patient care)

• You have not yet received a dose of the COVID-19 vaccine

• You are available for a follow-up dose between February 26-28

• You are willing to wait in the parking lot outside of Centennial Hall this weekend for 30-60 minutes at the end of each clinic

People who might be interested in this opportunity include:

• A senior (age 65 or older) or a health care worker who is already signed up for the February 11-12 clinic and who is willing to get the vaccine one week earlier

• A senior (age 65 or older) or a health care worker who has a schedule conflict with the February 11-12 vaccine clinic

A handful of individuals will be randomly picked for each day and will receive a phone call if selected. Even if you are called to wait, you may not get the vaccine; it will depend on how many extra doses are left over at the end of each clinic. CBJ appreciates those eligible individuals who are willing to sign up and wait. Signing up to help with this process will not jeopardize your appointment at the 11-12 clinic if you are not selected.