Public Signup for Covid Contacting
Public Signup for Covid Contacting



Schoharie County is gathering contact information for those residents interested in receiving the COVID Vaccine

This information is to create a contact list for us to reach out when vaccine is available

This entry form is NOT for scheduling an appointment

Enter Information then scroll to bottom of page and click Save



First Name .......(mandatory)

Last Name: .......(mandatory)

Date of Birth:


Physical Street Address:

Village/Town:

Resident County:

State: ................Zip Code:


One of the following three fields must be have information so we may contact you

Email Address:

Home Phone #: ....... (enter as ###-###-####)

Mobile Phone #: ....... (enter as ###-###-####)




Reason for wanting vaccine












Employer:

Job Title:


Eligible New Yorkers in Phase 1a and 1b are


................