Vaccine Registration

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Notification List Signup

A safe and effective COVID-19 vaccine plays a critical role in providing protection against the virus, preventing illness and saving lives. Vaccine is currently in limited supply and health officials are using a phased approach.

As supply increases, more people will be able to get vaccinated. This simple form allows you to register to receive vaccine. Please add your name and contact information below and the Lincoln-Lancaster County Health Department will notify you when vaccine is available.

 

Please Enter Your Information
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  * m/d/yyyy
  Minor children 18 years of age and younger must be accompanied by a parent or legal designee.

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    (000) 000-000
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Contact Method:  


Health Information



If you don't have one, please leave it blank.





 



  • First Name Required
  • Last Name Required
  • Date of Birth Required
  • Gender Required
  • Race Required
  • Ethnicity Required
  • Address Required
  • City Required
  • Zip code Required
  • Preferred Phone Required