Please answer these questions and complete the registration for yourself before you complete the registration for your dependents.
I hereby certify under penalty of law that I am eligible to receive COVID-19 vaccine, or the person for whom I am legally authorized to make health care decisions for is eligible to receive COVID-19 vaccine, because:
1. I am a resident of New York State (or the person for whom I am legally authorized to make health care decisions is a resident of New York State). OR
2. I perform work in New York (or the person for whom I am legally authorized to make health care decisions performs work in New York State). OR
3. I study in New York State. I understand that I will have to supply proof of eligibility. I agree that by clicking “I agree” and continuing below, I am hereby affixing my electronic signature as if I had physically signed this certification.