Vaccine Information

The County of Ventura is seeking volunteers to assist with COVID-19 vaccinations. The State of California has provided a list of authorized vaccinators that can be viewed here. If you are listed on the state list as an authorized vaccinator please complete and submit the following form.
* = Required
Name*
First Last
Address*
Street City State Zip Code
Phone*
Email*
Licensees Authorized to Administer Vaccines in California*
Professional License Number*
Liability Form
DOWNLOAD, REVIEW & SIGN, and UPLOAD the Liability Form here
If unable to upload an electronically or otherwise signed Liability form, please bring with you to your first vaccinator assignment.
Upload Signed Liability Form