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Vaccine Information
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Vaccine Information
Please sign up below if you are interested in receiving information on COVID-19 vaccines for Indigenous people living in urban areas and away from home (Inuit, Métis, and First Nation People who are not living on a reserve they hold membership with).
*Note: This is not a vaccine registration list.*
Please enable JavaScript in your browser to complete this form.
Name
First
Last
Phone
Email
*
City/Town
*
Age Group
65+
50-64
40-49
30-39
18-29
0-17
Do you want the COVID-19 vaccine?
Yes
No
Not sure
Do you require more information about vaccines and potential side effects before you make a decision?
Yes
No
Would you like to add your name to a list of urban/away from home Indigenous people interested in receiving the COVID-19 vaccine when it becomes available and safely accessible?
Yes, please add my name
No, do not add my name
(This is for information sharing only and is not a registration for receiving the vaccine.)
Submit