Vaccine Waitlist

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Vaccine Wait List Request Form
Monday, April 5th - Saturday, April 10th

*Please fill out ALL of this form and someone from our team will be in contact with you should an opportunity arise. If you receive a call, please arrive within 20 minutes of the phone call or the vaccine will be offered to the next available person. A valid photo ID is required.

Name*

Email*

Phone Number*

Yes, it's okay to send me text messages including confirmations, changes, and updates. Message frequency varies. Message and data rates may apply. Reply STOP to cancel. View our terms of service & privacy policy.

Day of Preference or "Any Day" (no guarantee that we will call you on that day)*

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