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COVID-19 Vaccine Standby List Sign Up

  1. Please read and respond to each of the following. We will review your responses and add you to the standby list if you qualify.
  2. I am currently eligible to receive the COVID-19 Vaccine based on the criteria set by NYS.*
  3. I currently live or work in Schuyler County.*
  4. I understand that this is not a wait list. By filling out this form, I am requesting to be added to the County's standby list. If someone is a no-show for their appointment - I may be called if I am the next person on the standby list.*
  5. I understand that I will be expected to arrive in a timely manner if I am called and agree to fill in the spot for the person who did not show up for their appointment.*
  6. I agree that I will still do my best to find an appointment elsewhere.*
  7. If I am able to get my vaccine elsewhere, I will contact Schuyler County Public Health to remove my name from the standby list.*
  8. Once you read and acknowledge the above, please enter your name, contact information, home address, and work address (if applicable) below.
  9. Home Address
  10. Work Address
  11. Leave This Blank:

  12. This field is not part of the form submission.