Vaccination Center Online Volunteer Form

2. The Town of East Hampton is renewing its call for volunteers to help at town vaccination clinics that are being held at the EH Town Center for Humanity (former Child Development Center of the Hamptons school) in Wainscott. Clinic dates will be determined based on week-to-week availability of vaccine (often on short notice based on last-minute notification to the town). If you are willing to volunteer please fill out the form at the following link. Please wait to be contacted after you submit the volunteer form; Due to volume, we cannot respond to individuals or phone inquiries. We cannot guarantee that you can be vaccinated should you volunteer.
4. First Name*
5. Last Name*
7. Phone *
8. Email address:*
10. Please indicate what tasks you can assist with:

    1. Outdoor Traffic Control
    2. Greeter/ Indoor Traffic Control
    3. Intake/Data Input
    4. IT technical assistance
    5. IT non-technical assistance (assisting patients with completion of electronic forms, etc.)
12. Please indicate which Professional / Medical tasks you can assist with:

    1. I am a licensed medical professional
    2. I am a professional in a medical field/category and am eligible for NYS certification as a vaccinator
    3. I have already been certified by the State of New York as a vaccinator
14. For information about NYS Certification as a Vaccinator, click here:
    https://covid19vaccine.health.ny.gov/vaccination-training
Leave This Blank:


15. 1. Receive an email copy of this form.
16. Email address

    This field is not part of the form submission.

17. Submit

* indicates a required field