Vaccine Clinic Sign Up

We are excited to let you know that Imagine! and the Association for Community Living (ACL), working with Boulder County Public Health, will be hosting TWO COVID-19 vaccination clinics.

Please check with your doctor to make sure it is safe for you to get the vaccine.

If you have a guardian, they need to come with you to get the vaccine. If they can’t come with you, they need to sign a consent form that you can bring with you.

These vaccination clinics are to vaccinate as many people with disabilities as possible under the 1B3 Phase. If you are a parent, guardian, or provider who fits the criteria of 1B3, please add yourself to the standby list by checking the box on the form.

For Confirmation Email
For Potential Contact

* People age 60 and older.

* Frontline essential workers in grocery and agriculture: The intent of this classification is to prioritize current workers who cannot maintain physical distance from others at their place of employment, who work in close contact with many people, especially indoors, and in places with poor ventilation including meatpacking workers; grocery store workers; and agricultural processing workers.

* People age 18-59 with two or more of the following: Cancer (defined as patients who are currently receiving treatment or have received treatment within the last month for cancer), chronic kidney disease, COPD, diabetes mellitus (types 1 and 2), Down syndrome, specific heart conditions (heart failure, cardiomyopathies or coronary heart disease, and severe valvular/congenital heart disease), obesity (BMI of 30 or more), pregnancy, sickle cell disease, solid organ transplant, individuals with disabilities who require direct care in their home, and people with disabilities that prevent them from wearing masks.

Choose One

The time that you sign up for will be for both dates at the same time (first dose and second dose).

If you are unable to attend these clinics because you have a scheduling conflict, need additional support, or would rather get your vaccination at a smaller clinic, we hope to set up more opportunities in the near future. Please check the box below to let us know if you are interested in a different opportunity. We strongly encourage you to sign up for the Fairgrounds Clinic, however as the others are not guaranteed.

If you want the vaccine but you need help understanding this form or filling it out, please call 303-457-5717. You can also call your Case Manager, Family Support Navigator or your Provider.

Si necesita ayuda en español, por favor llame a su administrador/a de casos o al navegador de apoyo familiar para que puedan ayudar. También tendremos voluntarios que hablan español en el evento.