COVID-19 Interest Forms

We are not currently able to register everyone who is eligible for vaccination. Our weekly vaccine allocation is much lower than the number of people in the current phase, 1B. We ask that you do not widely share registration links with those who would be ineligible for an appointment. Our team verifies all appointments before administering vaccine. If you make an appointment and are not part of a priority group, you will be turned away. Our team is working to organize clinics as quickly as our vaccine supply allows.

For more details on our vaccination planning, visit our vaccination web page.

If you are interested in receiving the COVID-19 vaccine, please complete the appropriate interest form, below. This is NOT a registration form.

We will contact people who complete this form with additional information on registration as it becomes available. Please complete one form per person. If you need assistance completing the form, please call our call center at 410-876-4848, open Monday-Friday, 8 am – 5 pm. Please be patient. We are experiencing an extremely high volume of calls.

Please make sure you are filling out the correct form. You will need to bring a photo ID and proof of eligibility to vaccination clinics.

We currently have the Moderna vaccine at the Carroll County Health Department and the Moderna vaccine can only be offered to individuals ages 18+.

The Carroll County Health Department (CCHD) cannot provide any medical advice regarding whether or not you should receive the vaccine. You should talk to your healthcare provider before signing up to receive the vaccine.  The CCHD reserves the right to decline to vaccinate any individual we do not feel safe vaccinating as we have limited medical support services on site. For CDC information on underlying health conditions and COVID-19 vaccination: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations/underlying-conditions.html

Phase 1A

Phase 1A: If you are a health care provider, law enforcement officer, or first responder in 1A, and you live or work in Carroll County, please complete this form to be on our interest list for the COVID-19 vaccine: 

https://docs.google.com/forms/d/1JSRonZPZWpiM9I4lgQA9BzocH1jyrPDsefPhhD3SN4M/edit?usp=sharing

Phase 1B: If you work at a private school or childcare agency in Carroll County, please speak with your school administration or childcare owner about vaccination.

We may not plan additional targeted clinics for these groups. We will keep people on the list informed of other opportunities. You are eligible to be vaccinated at other sites and may want to try to find an appointment through retail pharmacies, large clinics, or the state’s mass vaccination sites: https://coronavirus.maryland.gov/pages/vaccine#locator