Vaccination Validation Form
EVERYONE IN ATTENDANCE WHO IS ELIGIBLE TO BE VACCINATED (AGE 12 AND OLDER) WILL BE REQUIRED TO PROVIDE PROOF OF VACCINATION AT THE TIME OF SIGN UP.
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I understand that I am required to adhere to health guidelines such as social distancing and wearing a mask when indoors, if attending onsite.
Which COVID-19 Vaccine did you receive?
Johnson & Johnson
On which date did you receive your 1st dose?
On which date did you receive your 2nd dose?
If you received the Johnson & Johnson COVID-19 Vaccine, please select the date of your 1st dose for this question.
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