Starr Library - Rhinebeck Responds Vaccination Sign Up for Volunteers
Thank you for expressing an interest in assisting people to sign up for COVID-19 vaccinations.  Please complete the information below and you will be contacted by the Volunteer Coordinator.  Don't worry if you have NOT had prior experience with the vaccine registration process, we will attempt to provide education and assistance.

OUR GOAL
To assist people who are having difficulty making vaccine appointments.  This will include visiting websites and making phone calls on behalf of another individual.  As part of that process, we will be collecting sensitive personal information.  All information collected will be kept STRICTLY CONFIDENTIAL.  All interactions with people seeking assistance will be done with a respectful and caring attitude.

As a group we will look to share our experience and expertise with each other.

Sign in to Google to save your progress. Learn more
Email *
Name *
Phone number (Suggest Cell Number, but fill in best number to contact you) *
Are you fluent or able to communicate in another language?
Describe your prior experience with vaccination registration in New York.
Questions or Comments
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy