Welcome to our online COVID-19 vaccine registration form. Please fill out the information as accurately as possible. We will be using this form to gather information on who is interested in the vaccine and will use this to establish a vaccine registration list. Please be aware that there is currently no specific timeline on when you may receive the vaccine as the supply of the vaccine is not consistent. All of the information that is filled out on the following pages is secured on a database that meets Personal Health Information Protection Act standards.

To Register follow this link below (Just Click it to begin registration)

https://ocean.cognisantmd.com/intake/IntakePortal.html?eReqRef=e214c1e9-1224-41f9-b8e6-8059dd4dfe5a