COVID-19 Vaccination Waiting List Home > COVID-19 Vaccination Waiting List COVID-19 Vaccination Waiting List Are you currently 65 years of age or older?*YesNoIf you are currently under the age of 65, the Allegany County Department of Health is not currently accepting information for these age groups/priority groups. If you are under the age of 65 and need assistance with registration, please contact the Allegany County Department of Health at 585-268-9250 and we would be happy to assist you.Name* First Last Date of Birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Are you considered an essential worker under the State guidance for Phase 1B?*Check if you qualify hereYesNoPrimary Phone*Secondary PhonePhysical Address*NO P.O. Boxes Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code County of Residence*AlbanyAlleganyBronxBroomeCattaraugusCayugaChautauquaChemungChenangoClintonColumbiaCortlandDelawareDutchessErieEssexFranklinFultonGeneseeGreeneHamiltonHerkimerJeffersonKingsLewisLivingstonMadisonMonroeMontgomeryNassauNew YorkNiagaraOneidaOnondagaOntarioOrangeOrleansOswegoOtsegoPutnamQueensRensselaerRichmondRocklandSaint LawrenceSaratogaSchenectadySchoharieSchuylerSenecaSteubenSuffolkSullivanTiogaTompkinsUlsterWarrenWashingtonWayneWestchesterWyomingYatesDo you currently have internet access?*YesNoDo you have an e-mail address?*YesNoEmail Address* Enter Email Confirm Email Do you need assistance with registration?*YesNoIf you are entering information on behalf of an agency, please list your agency:Additional InformationTerms*By clicking 'I agree' below, I hereby agree and consent to your personal data being stored by Allegany County for the purposes of COVID-19 vaccination notification. This data may be shared with third party organizations for the sole purpose of COVID-19 vaccine registration. My consent and/or information may be removed at any point in time by submitting a request in writing to the Allegany County Department of Health. If you are calling in to the office, you are verbally consenting to your information being stored and shared based on the information above. I agree*Consent*By clicking 'I agree' below, I attest, under penalty of law, that I am 65 years of age or older. When registered for the COVID-19 vaccine, I understand that I must provide proof of my age and I may be turned away if I do not have proof or if I am not 65 years of age or older. Please bring your insurance card as well as photo identification with you to the vaccination clinic. There is no implied or other guarantee that because your information is taken/entered that you are guaranteed a COVID-19 vaccine. The COVID-19 vaccine is currently based upon a prioritization of groups and individuals set forth by New York State. I agree*Initials of Person Entering Information*CAPTCHAPhoneThis field is for validation purposes and should be left unchanged.