St M Student Vaccination Status

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St M Student Vaccination Status

Understanding the vaccination status of our students is important as we continue planning for Fall 2021.

Families, please complete a separate form FOR EACH MIDDLE SCHOOL CHILD no later than Friday, August 6.

This information will be kept confidential.

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Student Name

Your answer

Student Grade

Grade 6

Grade 7

Grade 8

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What is the COVID-19 vaccination status of your child? *

Yes, fully vaccinated

Yes, partially vaccinated/vaccination in progress

No, not vaccinated

No, but vaccine is planned/scheduled

Prefer not to answer

Based on my child's age, my child is not eligible for the vaccine

Other:

Submit

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