Form Center

By signing in or creating an account, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.

COVID-19 Vaccine Registration Form

  1. This is a Registration Form only, not an Appointment.

    This form will allow people who live in Lawrence to register for a COVID-19 vaccination through the City of Lawrence. The City's ability to hold vaccination clinics is dependent on vaccine availability. If you can access the vaccine through other means, you should do so. Once you have registered you will be added to our waitlist. The City will follow the State’s prioritization process for vaccines. Once the City receives its vaccine doses from the State, health officials will set up clinics in City. We will call people on a first-come, first-served based on prioritization with instructions to schedule your vaccine appointment.

  2. Do you live in The City of Lawrence?*

  3. What Phase Do you Qualify For?

  4. Phase 1

    (December 2020 – February 2021) Listed in order of priority:

  5. Phase 2 Group 1:

  6. Phase 2 Group 2:

  7. Phase 2 eligible conditions:

  8. Phase 2 Group 3: Other workers, including:

  9. Group 4: Individuals with one certain medical condition

  10. Phase 3 (Starting April 2021)

    If your group is not specifically listed in either Phase 1 or Phase 2, you will be eligible to receive the vaccine in Phase 3, which we expect to launch in April. The vaccine is expected to be available to the general public, including:

  11. Leave This Blank:

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