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. 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 when vaccines are available for your tier. CLICK HERE for more details on who is included in each of the tiers below. 

Once you submit this form, you will receive an email confirming your inclusion in the pool. We cannot estimate when vaccine will be available for each tier. 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. To minimize strain on the phone system, please only call if you experience difficulty submitting this form. 

Categories

At least one of the following categories must be selected and you will be required to show relevant ID during your appointment. For a more detailed description of these eligible lanes, please visit SNHD COVID-19 Vaccine Distribution.

Check all relevant categories that apply to you