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This form is intended to be filled out by individuals who live or work in Oak Park and are eligible to receive a COVID-19 vaccine under the state's vaccine distribution plan.

Oak Park’s pre-registration form is now open to individuals age 16 and older who fit any one of the following categories:

Phase 1a

Phase 1b

Phase 1b plus

All Other Oak Park Residents

As vaccine supply remains limited, the Oak Park Public Health Department will continue to prioritize those eligible in Phases 1a, 1b and 1b plus before moving to all other residents.

Proof of age, residency and/or employment as a essential worker will be required at all Phase 1b vaccine clinics hosted by the Oak Park Department of Public Health.

For households with more than one eligible individual, each person should complete the form separately.

I have reviewed and agree to above statements.

For your security, click on EXIT when done.