Vaccine Waitlist #4

This is the City of Seguin's 4th COVID Vaccine Waitlist. As vaccines become available, you will receive an invitation to schedule an appointment. You will be able to register up to two people once you receive your invitation to schedule your appointment. Please provide your information below and the two individuals who will be receiving the vaccine.

YOU WILL NOT RECEIVE A CONFIRMATION EMAIL THAT YOU ARE ON THE WAITLIST. AFTER CLICKING THE DONE BUTTON, YOU WILL SEE A PAGE SAYING YOU HAVE SUCCESSFULLY COMPLETED THE WAIT LIST SIGN UP.

If you do not have internet access or an email, please call (830) 386-2219 to be placed on the waitlist.

Question Title

* 1. Please provide your contact information. The invitation to schedule appointments will be sent to the email address provided here.

First Name

Last Name

Email Address

Phone Number

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* 2. When you receive an invitation to schedule a vaccine appointment, you will be able to register up to two people for a vaccine. How many individuals will you be registering for a vaccine?

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* 3. Vaccine Recipient #1's Information

First Name

Last Name

Home Address

City/Town

State/Province

ZIP/Postal Code

Date of Birth

Email Address

Phone Number

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* 4. Vaccine Recipient #1 is eligible to receive the COVID vaccine as they meet the following conditions: (Mark all that apply)

1A - First Responder

1B - 65+ or 18+ with a preexisting condition

Educator/Licensed Childcare Personnel - Grade School, Day Care or Higher Education

1C - Age 50 - 64

Between the ages of 18 - 50

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* 5. Vaccine Recipient #2's Information

First Name

Last Name

Home Address

City/Town

State/Province

ZIP/Postal Code

Date of Birth

Email Address

Phone Number

Question Title

* 6. Vaccine Recipient #2 is eligible to receive the COVID vaccine as they meet the following conditions: (Mark all that apply)

1A - First Responder

1B - 65+ or 18+ with a preexisting condition

Educator/Licensed Childcare Personnel - Grade School, Day Care or Higher Education

1C - Age 50 - 64

Between the ages of 18 - 50