Missanabie Cree First Nation is interested in finding out who within our community wants the Covid-19 vaccine. As our community members are stretched out across North America, the health unit understands that we are limited in how we can distribute the vaccine to our members. This survey is designed to have you the members let us know where your location is, what health unit is within the community that you live in, and the list of names and dates of birth of each person wanting the vaccine.
Please note: This survey is not a guarantee that you will get your vaccination through Missanabie Cree First Nation or your local health unit, this is just the start towards ensuring the health unit and our government knows how many of us is interested in receiving the vaccine. Thank you for your co-operation.

Question Title

* 4. Please provide the name of the public health unit nearest you

Question Title

* 5. Please enter your contact information.

Question Title

* 6. Your household living situation:

Question Title

* 7. Person #1 - Person filling out this survey

Question Title

* 8. Are you status, non-status, or not status. (Non-status means you are not registered as status but are eligible or not eligible to gain status but identify as First Nation or Metis)

Question Title

* 9. If applicable, please provide the last 6 digits of your status card

Question Title

* 10. Person #2

Question Title

* 11. Is person #2 status, non-status, or not status.

Question Title

* 12. If applicable, please provide person #2's last 6 digits of their status card

Question Title

* 13. Person #3

Question Title

* 14. Is person #3 status, non-status, or not status.

Question Title

* 15. If applicable, please provide person #3's last 6 digits of their status card

Question Title

* 16. Person #4

Question Title

* 17. Is person #4 status, non-status, or not status.

Question Title

* 18. If applicable, please provide person #4's last 6 digits of their status card

Question Title

* 19. Person #5

Question Title

* 20. Is person #5 status, non-status, or not status.

Question Title

* 21. If applicable, please provide person #5's last 6 digits of their status card

Question Title

* 22. Person #6

Question Title

* 23. Is person #6 status, non-status, or not status.

Question Title

* 24. If applicable, please provide person #6's last 6 digits of their status card

Question Title

* 25. Person #7

Question Title

* 26. Is person #7 status, non-status, or not status.

Question Title

* 27. If applicable, please provide person #7's last 6 digits of their status card

Question Title

* 28. Person #8

Question Title

* 29. Is person #8 status, non-status, or not status.

Question Title

* 30. If applicable, please provide person #8's last 6 digits of their status card

Question Title

* 31. Person #9

Question Title

* 32. Is person #9 status, non-status, or not status.

Question Title

* 33. If applicable, please provide person #9's last 6 digits of their status card

Question Title

* 34. Person #10

Question Title

* 35. Is person #10 status, non-status, or not status.

Question Title

* 36. If applicable, please provide person #10's last 6 digits of their status card

Question Title

* 37. Person #11

Question Title

* 38. Is person #11 status, non-status, or not status.

Question Title

* 39. If applicable, please provide person #11's last 6 digits of their status card

Question Title

* 40. Person #12

Question Title

* 41. Is person #12 status, non-status, or not status.

Question Title

* 42. If applicable, please provide person #12's last 6 digits of their status card

T