Saratoga County is working to deliver vaccine to residents in a phased approach, in accordance with New York State requirements. The purpose of this form is to gather information from residents interested in receiving COVID-19 vaccination. Your answers to the questions will determine if you are able to get the COVID-19 vaccine from Saratoga County. While New York State requires Saratoga County Public Health Services to restrict administration of vaccine to certain groups, all eligible individuals can be vaccinated at New York State operated vaccination locations. Pharmacies, federally qualified health centers and ambulatory centers can also vaccinate specific groups. Click here for information on other locations.

All information entered on this form will be kept confidential. Providing your information for this interest list does not reserve or guarantee a vaccination. You will be contacted when a vaccination appointment is available through Saratoga County. Proof of eligibility will be required at the time of vaccination.

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With the understanding that I will have to supply proof of my eligibility, I hereby certify under penalty of law that I am an adult, reside in New York State, and belong to one or more of the following groups eligible for vaccination.

If my eligibility is based upon occupation, I further certify that I currently perform work in one of the below categories, either paid or unpaid, or I am a non-resident but perform such work in New York; and I am either required to have in-person contact with members of the public or with coworkers, or I am unable to work remotely.

If my eligibility is based upon pre-existing medical condition(s), I further certify that, to the best of my knowledge and belief, I have one or more of these conditions.

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