COVID-19 Vaccination Pre-Registration Form

CNLV Logo City of North Las Vegas COVID-19 Vaccination Pre-Registration Form

Welcome to the City of North Las Vegas' COVID -19 Vaccination Pool for residents 70 and older. Please complete the form below to pre-register for a COVID-19 vaccine. NOTE: Completing this form does not schedule you for a vaccine appointment. You will be contacted at the email or phone number you provide below to schedule your vaccination appointment. Vaccinations for seniors 70 and older will begin Jan. 19. All eligible residents who have pre-registered will be randomly selected for scheduling, regardless of the order that the form below was received. Once you submit this form, you will receive an email detailing the next steps, anticipated scheduling timelines, and confirming your inclusion in the pool. If you need assistance with the form, you may call (702) 342-8417. Please note: Due to limited capacity and unprecedented demand, callers may be required to leave a voicemail on our phone system. We will return your call as soon as possible and ensure that all eligible residents opting into the pool are confirmed prior to beginning the randomized scheduling process. To minimize strain on the phone system, please only call if you experience difficulty submitting this form.