Darul Qasim Vaccine Data Collection Form
The Darul Qasim Safety Committee would like your cooperation in gathering data regarding COVID vaccinations and infections. Darul Qasim does not mandate that a student/faculty/staff get vaccinated. Your registration or admission is not impacted by this information.

This information has proven crucial in assisting those that may have been affected by COVID and to manage contact tracing. Please fill out this form to the best of your knowledge. This form is to update any previous, or gather new, information so please complete the entire form. Your participation is extremely valuable. JazakAllahu Khairan.
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Full Name *
Have you contracted COVID or any of its variants? *
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