Covid-19 Vaccination Sign-Up | Registro de Vacunación para COVID-19 Company Your Info | Tu información Let us know how to get back to you.Háganos saber cómo contactarte. First Name | Primer Nombre * Last Name | Apellido * Phone | Numero De Teléfono * Email Address | Correo Electrónico * Age | Edad * Birthdate | Fecha de Nacimiento * We will be following Oregon Health Authority priorities shown here (click for PDF). Brief explanation of why you qualify | Breve explicación de por qué califica para la vacuna * Please download these forms and have them complete before you arrive at your appointment. Screening Form (English | Spanish) and Consent Form (English | Spanish) Do you need to have hardcopies of the forms mailed to you? (No printer) Yes No If yes, please enter your full mailing address including zip code