Hatzoloh Vaccinate Thornhill Event - Sunday June 23rd 9am-12pm at BAYT

Thank you for starting the registration process for the Hatzoloh Vaccinate Thornhill Event!
This registration should take 30 seconds per person.
We are collecting email and phone contact information in order to communicate with you regarding this event, and potentially communicate with you later on regarding your vaccination. The information collected in this form, including phone/email details will not be shared with third parties not related to this initiative.

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* 1. Please enter the following information

First Name

Last Name

Best phone contact

Best email contact

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* 2. How many doses of the MMR vaccine have you received?

None

One

Two

I do not know.

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* 3. What is your age?

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* 4. The Vaccinate Thornhill Event will be held on Sunday June 23rd at a location in Thornhill (to be confirmed) from 9am-12pm. In order to ensure an orderly flow and minimize the time you spend getting vaccinated, please chose the time you plan to attend. We are only allowing 100 people per time slot so please do arrive at your chosen time.

9:00am

9:15am

9:30am

9:45am

10:00am

10:15am

10:30am

10:45am

11:00am

11:15am

11:30am

11:45am

12:00pm

A few important reminders:

1. Each online registration is for one person only. If you are coming with other family members or friends please register each person individually by clicking on the survey link again.

2. The vaccination clinic is free, however, we ask that you bring your OHIP card so that the costs of providing this service can be defrayed. If you have your 'yellow card' as well, please do bring it so we can complete it onsite.

3. If you are pregnant (or may be pregnant) or are on immunocompromising medication you will not be able to receive the MMR vaccine.

To enter another individual or family member, click here: https://tinyurl.com/MMRTHORNHILL

To review a Frequently Asked Questions and Information sheet, click here.

Thank you for choosing to protect yourself and the community.

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* 5. SPECIAL NOTE: A number of community members who are also scientists have partnered with University of Toronto researchers to allow clinic attendees who are interested to participate in a research study on measles/mumps/rubella immunity. The study involves completing an additional questionnaire and a draw of blood at the clinic (about 5-10min extra) prior to getting the vaccine. Participants blood will be tested for MMR immunity using methods beyond those available through their physician. The standard titre results will be communicated back to participants. A maximum of 50 people will be able to participate in this study. Further information and a full consent process will be provided for those who choose to participate.

If you are interested in participating in this research study please select 'yes' below.

No, I am not interested

Yes, I am interested in voluntarily participating in this research study