COVID VACCINE REPORT (05.05.2022)
Please fill in the forms carefull.
Roll number has to be full.
Name should start with Capital Letter followed by lowercase (e.g. Jonathan Prince, MK Mandy)
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Roll Number *
Full Name *
Date of Birth *
MM
/
DD
/
YYYY
Class *
Section *
Covid 19 vaccinated *
If Vaccinated - Date of First Dose
MM
/
DD
/
YYYY
If Vaccinated - Date of Second Dose
MM
/
DD
/
YYYY
If not Vaccinated - Resons (in brief)
If not Vaccinated - Do you want to take?
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