Because Your Health Matters!

Receive a $25 gift card when you qualify for a COVID vaccination! This offer is specifically for individuals aged 65 and older or those experiencing homelessness.

Sponsored by the Department of Public Health, it’s our way of supporting your health and wellness. Don’t miss out—register today!

Because Your Health Matters!

Receive a $25 gift card when you qualify for a COVID vaccination! This offer is specifically for individuals aged 65 and older or those experiencing homelessness.

Sponsored by the Department of Public Health, it’s our way of supporting your health and wellness. Don’t miss out—register today!

Free $25 Gift Card

We are excited to offer a $25 gift card to eligible individuals who qualify through our COVID-19 vaccination program. This initiative supports individuals aged 65 and older or those experiencing homelessness. Please fill out the form below to confirm your eligibility and claim your gift card.

Eligibility Information

First Name *

Last Name *

Date of birth *

Are you aged 65 or older? *

Yes

No

Do you currently lack stable housing or a permanent place to stay?

Yes

No

Contact Information

Email *

Phone *

Vaccination Status

Have you received your COVID vaccination?

Yes

No

If Yes, where and when did you receive it?

Gift Card Distribution

Preferred Method to Receive Gift Card

In-person

Mailed to Address (if applicable)

Consent

By submitting this form, you confirm that the information provided is accurate and will be used to determine your eligibility for the gift card.

Signature

Clear

Date

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