Senior Center to Co-Host COVID-19 Vaccine Clinic

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*Update as of 4/23/21*

The form to request an appointment for this vaccine clinic is now closed.  Anyone who completed the form should receive a phone call for an appointment by Monday, April 26.


The Middletown Township Senior Citizens Association is partnering with Rite Aid to hold a COVID-19 vaccination clinic on Wednesday, April 28th.  Rite Aid plans to distribute the two-shot Pfizer COVID-19 vaccine.

Please fill out this form for one individual.  If more than one person needs a COVID-19 vaccine, please fill out the form again for each additional person.

Filling out this form does not guarantee a COVID-19 vaccine.  Individuals completing this form will be contacted by phone to schedule an appointment.  Appointments will be booked until none are available.  As this is a one-time clinic, anyone who is unable to attend this clinic should continue to pursue other means to obtain a vaccine.