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COVID - 19 Vaccination Registry

  1. Provide your personal information for the Covid-19 Registry
  2. This registry is for vaccine distribution for East Greenwich residents ONLY.
    Please use this form if you are over the age of 65 to provide your information now. This information will be used in future months to communicate directly with you when an opportunity becomes available to register you to receive the vaccine at a future clinic in accordance with the guidelines published by the State Department of Health. You will be required to present proof of identity and age at the time of vaccination.
  3. Please Note
    The State of RI is currently supplying each City and Town with an extremely limited number of doses each week, and the Town of East Greenwich has no control over this process. It may be several weeks or more before you are contacted to schedule your vaccination. The State may also change this procedure in the future, and we will update our website accordingly.
  4. Personal Information
  5. Address Information
  6. Alternate Contact Person (Optional)
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  8. This field is not part of the form submission.