Planet Homeschool COVID-19 Vaccination Affidavit and Assumption of Risk
Everyone ages 12 and older (including caregivers) must be fully vaccinated against COVID-19 to be onsite for our Fall 2021 semester, with limited exceptions. A person is considered fully vaccinated 14 days after completing the full course of a vaccine series, which means you should plan to have completed your vaccination series no later than Friday, August 27, 2021.
• Exemptions will be granted to accommodate individuals with health conditions that preclude vaccination.
• Students younger than 12 are exempt until a vaccine becomes available for them.
• Keeping family members who are not taking classes or volunteering at PHS offsite if at all possible will help our community minimize potential sources of exposure.
Any authorized COVID-19 vaccine is acceptable. Currently, three vaccines are authorized and recommended for adults in the United States to prevent COVID-19: Pfizer-BioNTech, Moderna, and Johnson & Johnson’s Janssen. The Pfizer-BioNTech vaccine is authorized for ages 12 and up.
If you receive a vaccine that requires two shots, you will need to wait until you’ve received the second shot before you may submit this form. If you receive a COVID-19 vaccine that requires only one dose, then you may submit this form after the single shot.
Planet Homeschool’s COVID-19 Policies for Fall Semester 2021 can be found at
A confirmation that you've completed this form will be sent to your email address. To help volunteers connect your form to your membership, please use the same email address that you entered as your family's primary email in your Family Profile.
Family Member #1
This form shall serve as my affidavit that:
the individual named above has completed their COVID-19 vaccination between December 11, 2020 and August 27, 2021.
all available COVID-19 vaccines are medically contraindicated for the individual named above.
the individual named above is less than 12 years of age.
Add additional Family Members
All families should have a minimum of 2 families members: at least 1 student and at least 1 adult volunteer.
I have additional family members taking classes or volunteering at PHS.
I have NO additional family members taking classes or volunteering at PHS.
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