Bethesda is working with the Niagara Region to gather information on how we can support families with choices regarding the COVID-19 vaccine for children ages 12-17. Please complete the following survey to help us identify how Bethesda can help.

Yes

Transportation support

Information about the vaccine

My child/youth would benefit from additional support staff at the vaccine appointment

Access to resources or materials to help my child/youth prepare for the COVID/19 vaccine

Support to book an appointment at a community clinic or pharmacy

Yes

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number