Brown County Minnesota COVID Vaccination Wait List
Brown County Public Health is continuing to offer COVID-19 vaccinations as we are allocated doses from the Minnesota Department of Health.
In effort to vaccinate all those who are interested in receiving a dose, this wait list will be used in the event that we have a short-notice cancellation.
By completing this form, your information will be saved and you will be contacted only when a dose is available.
Filling out this form does not guarantee you a dose of the COVID-19 Vaccine.
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What is your first nme? *
What is your last name? *
What is your phone number? *
What is your email address? *
What is your street address? *
What is your zip code? *
What is your gender? *
What is your birthdate? *
MM
/
DD
/
YYYY
What is your race? *
What is your ethinicity? *
Which category are you eligible with? *
Please define your employment category. *
Who is your employer? *
What is your occupation? *
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