Cloud Muni Vaccine Interest Form
Please complete the below form to let the Cloud Muni Health Department know that you would like to receive the COVID-19 vaccine. We will use the contact information to send you vaccine availability and location updates.
Address Details
@T["Draw a Polygon on Map"]
Select a Polygon type to draw in top right of map. Use your mouse to draw. On some types you have to double click to end the polygon.
Polygon Label must have no more than 30 character
Getting Address Details From Addressing System..
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Fill Manual Address
Select your location by clicking on the map to set a pin
Authorized Department
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False