Volunteer Sign-In

Please complete the following form to Sign-In to the EDS as a volunteer for the COVID-19 Vaccine.

*First Name

*Last Name

*Address

*City

*State

*Zip Code

*Email Address

*Phone Number
Example: 5085551234

*Volunteer Role

*Do you have any COVID symptoms or knowledge of recent exposure?

Yes No

*Do you plan to receive a COVID-19 vaccine today?

Yes No

NOTE: Please confirm your 2nd dose/2nd shift by responding to volunteer@worcesterma.gov.

Please note that the second dose is 21 days after if your first dose was Pfizer.

Volunteer Sign-In

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