Lyft Vaccine Form Getting the COVID-19 vaccine starts with getting to the vaccine. So we’ve teamed up with Lyft to make sure you have a reliable ride when you’re ready. The Vaccine Access partnership provides individuals with Down syndrome and their families and caregivers with Lyft credits to help them get to their vaccination appointment. If you decide not to participate in this survey or if you withdraw from participating at any time, you understand that you have opted out of receiving Lyft vaccine access credits from NDSS. The information you provide in this survey is for internal use only. This survey is confidential to protect the privacy of the individual. The data collected through this survey will be stored for NDSS’ reference only in a password encrypted file to protect people's personal information. You will hear from our NDSS team with your Lyft code within 2 business days of submitting the form. Name of the individual receiving the vaccine* First Last Address* City State / Province / Region ZIP / Postal Code Email* What is your relationship to the individual with Down syndrome?*I am an individual with Down syndromeI am a parentI am a caregiverI am a family memberHow many COVID-19 vaccine doses have you already received?* I have not received any COVID-19 vaccine doses I have received my first COVID-19 vaccine dose How did you hear about this program? NDSS Social Media NDSS Website NDSS Email Local Down Syndrome Organization Lyft Communications Other If you selected Other, please specify where:Do you need any other support from NDSS regarding COVID-19?YesNoIf you select yes, our NDSS team will reach out to you to provide additional support.