Hanover Area Covid Vaccine Declaration Form
Parents/Guardians must complete this form 1 time for each of their children age 12 and older. Disclosing your child's vaccination status and providing a copy of their Covid immunization card is OPTIONAL. However, IF YOU CHOOSE NOT TO SHARE, please know that your child will be handled in the same manner as an unvaccinated student.
Student First Name
Student Last Name
Covid Vaccination Status
Yes, my child is vaccinated and I will email a photo of the vaccine card for the School Nurse to verify with the state of Pennsylvania.
No, my child has not had the vaccine
I do not wish to share this information and acknowledge that my child will have to follow the policies and procedures put in place by the Hanover Area School District for unvaccinated students.
Never submit passwords through Google Forms.
This form was created inside of Hanover Area School District.