COVID-19 Vaccine Registration Form - Saturday, October 23
This form is used to sign up and receive a COVID-19 vaccination with the Thornton Fire Department.  Please fill out the form carefully and be sure not to sign up twice. You may edit your responses after you submit.

Appointments are highly encouraged for a faster check-in process and limited parking. THE CLINIC WILL BE HELD FROM 9AM - 4PM at Fire Station 5, 14051 Colorado Boulevard. Please park in the south parking lot at one of the signs and follow the instructions on the signs. Do not get out of your vehicle, we will come out to you.

To be eligible for a Pfizer or Moderna booster you must have received your second (2nd) Pfizer dose 6+ months ago, ~ on or before April 23, 2021.

*** Please bring your immunization card with you for 2nd doses and Boosters ***
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Email *
Legal Last Name *
Legal First Name *
Street Address *
City *
State *
Zipcode *
Phone Number *
Gender *
Date of Birth *
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Do you agree you are over the age of 12 for Pfizer? or Do you agree you are over the age of 18 for Moderna? *
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