Suquamish Tribe Vaccination Sign-up

If you are in an enrolled Suquamish Tribal Member and would like to schedule COVID-19 Vaccination for you and/or those who live with you in your immediate household, please fill out the following form. Once we receive your form, a scheduler will call to book your appointment as soon as possible.

Only one person in each household needs to submit this form.

You may schedule yourself and other members of your IMMEDIATE HOUSEHOLD who will be in the car with you. You can also schedule other members of your immediate household who need to come separately at another date/time.

For now, only those 18 years old and above can be vaccinated. Clinical studies need to be completed confirming the safety of the vaccine for those under 18 before it can be offered to them.

Please be prepared to schedule both first and second doses. The second shot needs to be administered about 28 days after the first.

Vaccinations are provided by appointment only at a drive-thru clinic on the ground floor of the Clearwater Casino garage. You can read fact sheets and learn more about our vaccination process here.

If you are unable to fill out this form or have questions, please call our Vaccination Hotline at 360-394-7191 and leave your name and phone number. You can also email vaccine_information@suquamish.nsn.us Someone will return your call/email as soon as possible.

Vaccination Sign-up

Name*
First Last Suffix
Phone*
Enter the number you'd like schedulers to call to book your vaccination appointment.
How many people in your household, including yourself, will you be scheduling for vaccination?*
Schedulers can book additional family members who will be coming with you in the same vehicle or separately on different dates/times.
Do you, or a member of your household that are you scheduling, have any of the following conditions?*
* Cancer * COPD * Heart conditions * Immunocompromised * Kidney disease * Obesity * Pregnancy * Sickle cell disease * Smoking * Type 2 diabetes
- Yes
- No
- Not sure
Tribal ID Number*
This can be the Tribal ID number of anyone in your immediate household. For example, if you are scheduling for you and your spouse, and your spouse is the Tribal member, enter their ID number here.
Confirm:*
- I attest that everyone submitted for scheduling is an IMMEDIATE member of a Tribal Household who lives in the same home.
- I attest that everyone submitted for scheduling will be at least 18 years old on the date of vaccination.