I Need Help Making An Appointment

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Let's Get Started...
Which category best describes you?*
(You can select more than one)
- I am a person with an intellectual or developmental disability
- I am registering on behalf of someone with an intellectual or developmental disability
- I do not have an intellectual or developmental disability and am not registering on behalf of someone with an intellectual or developmental disability
If you do not have an intellectual or developmental disability...
This support program is for people with intellectual or developmental disabilities and caregivers or supports registering on their behalf.
If you are looking to book a vaccine appointment please visit the Provincial Booking Site: https://covid-19.ontario.ca/book-vaccine/
What do you need help with?*
- Booking my first vaccine appointment.
- Booking my second vaccine appointment.
- Booking my booster dose.
Have you tried booking a COVID-19 Vaccine appointment?*
(Over the phone or online)
- Yes - I have tried to book an appointment
- No - I have not tried to book an appointment
Please check your local health unit first!
Before completing this form try clicking on the following link to book a vaccine appointment in your area. If you are still unable to book an appointment come on back and complete this form. CLICK HERE TO FIND A VACCINE LOCATION NEAR YOU
Have you received or booked your second dose of the COVID-19 vaccine?*
- Yes
- No - I need help
You Already Have An Appointment!
You have indicated that you already have a vaccination appointment or are fully vaccinated.

This form is for people with Intellectual or Developmental Disabilities who are having difficulty booking an appointment.

We encourage you to attend your scheduled vaccination appointments.

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Information About You!
First and Last Name*
Name of the person with an intellectual disability.
First Last
Contact Name
If different, please provide the name of the person we will be contacting to provide support. (This could be a parent, guardian, support person)
First Last
Phone Number*
Email Address
Enter Email Confirm Email
How would you like us to contact you?
You may select more than one.
- By Phone
- By Email
Date of Birth
DD slash MM slash YYYY
Age
You are this many years old.

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Help Us Find You!
Are you a Special Olympics athlete or registering someone that is a Special Olympics athlete?
- Yes
- No
What Special Olympics Ontario District and Community are you from?
Are you a Person with Down Syndrome or a member of the Down Syndrome Association of Ontario?
- Yes
- No
What Town or City do you live in?
Town / City Postal Code
How will you get to your appointment once it is scheduled?
- I can get there by myself (such as walking, driving or using public transportation)
- Someone will drive me or go with me
- I am not sure how I will get there

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Finishing Up....
Do you live with anyone who HAS NOT received a COVID-19 Vaccine appointment?*
- Yes
- No
How many of the people you live with have not received a vaccine appointment?
Please enter a number less than or equal to 10.
Please list the people in your household who have not received a vaccine appointment:
Availability of vaccines for households is different in each community, providing this information will help us support your household as vaccines become available.
Name Age Relationship to You
Confirmation*
Do you consent to share your information with Special Olympics Ontario and Down Syndrome Association of Ontario for the purpose of scheduling a COVID-19 Vaccine?

You MUST select YES to submit this form.
- Yes - I consent.
- No - I do not consent.
Click the "Submit Your Form!" button below!
Click the "Submit Your Form!" button below. If COVID-19 vaccine appointments are available for people with intellectual or developmental disabilities in your community you will be contacted by a Special Olympics Ontario volunteer who will help you book an appointment. Thank you for your patience as we connect with everyone who needs help.
Phone
This field is for validation purposes and should be left unchanged.

I NEED HELP BOOKING AN APPOINTMENT TO GET THE COVID-19 VACCINE

Complete This Form To Get Help!

Step 1 of 4 - Getting Started

Let's Get Started...

Information About You!

Help Us Find You!

Finishing Up....

Click the "Submit Your Form!" button below!

ACKNOWLEDGEMENT OF TRADITIONAL LAND

Name	Age	Relationship to You