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Manatee County Government

311@mymanatee.org

(941) 748-4501

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Sign Up for Manatee County's COVID-19 Vaccine Standby Pool

By registering here, your name will be added to a standby pool to receive the first dose of the COVID-19 vaccine, as vaccinations become available.

Recipients will be randomly selected from the pool. You will be contacted by Manatee County when you are selected. You can register up to two people together on this form to attend an appointment together. Duplicate entries will be removed.

Appointments will be made as quickly as vaccine doses are received by the county.

For more information, visit www.mymanatee.org/vaccine

If you have questions related to COVID-19 or the vaccine, please contact the Manatee County Department of Health.

Full Name

Are you 65 or older?

We are currently only registering those who are 65 and older. Please visit www.mymanatee.org/vaccine for more information.

If you are a patient-facing healthcare worker, please enter the Frontline Healthcare Worker Standby Pool at vax.mymanatee.org/frontline

Check here if you are deaf or hearing impaired and require accommodations when you are contacted

How should we contact you?

NOTE: Vaccine recipients must be full- or part-time Florida residents. At your appointment, you will be required to show a valid Florida driver's license or ID card, part-time rental agreement or utility, cable or power bill in your name with a Florida address. (See full list of acceptable documentation of residency.)

Would you like to include a second person (65 or older) on this registration? (You must be able to attend the appointment together. If not, please register separately.)

Full Name

We are currently only registering those who are 65 and older. Please visit www.mymanatee.org/vaccine for more information.

You will receive a Receipt Number on the following page after you submit. This number is confirmation that your registration has been submitted.

Receipt

You will be provided with a Receipt upon submission.