Vaccination Survey

Please be advised that you must be wearing a face covering for all in-person classes. In addition, you must have proof of vaccination.

Name

First Name

Last Name

Are you fully vaccinated?

According to CDC, a person is considered fully vaccinated 2 weeks after completion of a two-dose mRNA series (Pfizer-BioNTech or Moderna) or one dose of the Janssen vaccine.

Signature

Please type your name here. By typing your name below, you are signing this form electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this survey.