*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.