This form is being used to pre-register persons age 65+ for the COVID-19 vaccine in Harvey County.

Priority will be given to those people 65+ who live or work in Harvey County.

If you are age 65 or older and interested in receiving the vaccine, complete the information below.  You will be contacted for an appointment as vaccine becomes available.

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* 1. Legal First and Last Name

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* 2. Date of Birth

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* 3. Phone Number

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* 4. Street Address (no PO Box)

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* 5. City, State

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* 6. Place of Employment location

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