Arapahoe County Resident COVID-19 Vaccine sign-up

Name *

First

Last

Telephone Number: *

Town:

What town do you live in or what city do you use for mail?

Date of Birth

Please list your date of birth in mm dd yy format

I qualify for: *

Phase 1A: Highest risk Healthcare workers, long-term care facility staff & residents
Phase 1B.1: Age 70+, moderate risk healthcare workers & first responders (Law enforcement, EMS, Firefighters, correction officers)
Phase 1B.2: Age 65+, pre-K-12 educators and childcare workers & State Government
Phase 1B.3: Age 60+, frontline essential workers in grocery & agriculture, Age 16-59 with 2 or more high risk conditions
Phase 1B.4- Age 50+, student facing higher education employees, Frontline essential workers in food/restaurant, frontline essential workers in manufacturing, frontline essential workers for the US Postal Service, frontline essential workers in public transit and specialized transportation, frontline essential workers in public health, frontline essential workers in human services, frontline essential direct care providers for Coloradans experiencing homelessness, frontline essential journalists, continuity of local government, continuation of operations for state government, people with one or more high risk conditions listed on cdphe.com-
Phase 2: General Public

Please choose one option to help staff determine which phase of vaccination you qualify for.