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Health and Community Services Department

Caregiver of Individuals with Special Needs Waitlist Form

This is a pre-registration form for caregivers of individuals with special needs who are interested in receiving the COVID-19 vaccine. By submitting your information, you are placing your name on a waitlist with the health department. Note: Each person who is interested in receiving a vaccine and who qualifies under this category must submit a separate registration form. If you share an email address, you will receive only one email to schedule you appointments. Please be sure to register all parents/caregivers for a vaccine appointment that share the email address.

Please do not call the health department to confirm we received your form or when to expect your appointment. We are experiencing extremely high call volume. We encourage people to complete the online form so that the phone lines remain open to those who do not have a way to complete the form online or do not have technology to complete the form. We will notify you by using the contact information you provide when we have vaccine supply and appointments available to schedule.

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Please make sure your email address and phone number are entered correctly. This is how we will contact you to schedule an appointment. E-mail will be the quickest way to receive information.


  
  

  
  
  
  
  
  
  
  

  
  
  

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Contact Us

311 E. Alcott St
Kalamazoo, MI 49001

269-373-5200

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Kalamazoo County Health & Community Services is committed to providing equitable, culturally competent care to all individuals served, regardless of race, age, sex, color, national origin, religion, height, weight, marital status, political affiliation, sexual orientation, gender identity, or disability. 

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