The Village of Midlothian is diligently seeking COVID 19 vaccine opportunities to assist senior residents 65+. In the event we receive information on vaccine opportunities, we will notify seniors via email. The submission of the form does not guarantee access to the vaccination.
IMPORTANT INFORMATION- PLEASE READ:
- Completing this form DOES NOT guarantee access to the vaccination
- Completing this form will allow the Village to notify you, by email, of vaccine opportunities the Village becomes aware of
- You must have an email address to receive notice
- Only senior's and resident of Midlothian will receive notice
- At this time, Village staff does not have any additional information
Complete and submit form online
Print form
Complete and submit form online
Print form