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COVID-19 Vaccine Wait List for Middletown Residents

  1. Waitlist Information
    The City of Middletown has a waiting list for residents who are eligible to receive the COVID-19 vaccine. In the instance a vaccination clinic has extra doses or appointments available due to cancelations or no-shows, residents will be called at random to fill open appointment slots. This is not an appointment request, and submitting your information below does not guarantee you will be contacted to receive a vaccine. You must be eligible at the time of vaccination to receive a vaccine through this wait list. Residents are advised to continue to try and schedule an appointment through the Vaccine Administration Management System (VAMS) or other scheduling options. This information will not be shared with anyone outside of the City of Middletown.
  2. Please only use numbers,. Do not use spaces, dashes, or parenthesis.
  3. Age Range*
  4. Are you currently eligible for the COVID-19 vaccine?*
  5. Do you currently have an appointment scheduled in the Vaccine Administration Management System (VAMS)?*
  6. I declare that the information submitted above is accurate.*
  7. Leave This Blank:

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