COVID Attestation Form for ICCDU

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ICCDU attendees must attest that they have received the COVID-19 vaccination.

Email *

First Name *

Last Name *

Guest Phone Number *

This is provided in case there is a need for contact tracing following an event. You willnot receive any notifications from this form via text message or phone.

COVID-19 Vaccination Status *

I attest that I have received one of the WHO approved COVID-19 vaccines and that I am fully vaccinated against COVID-19.

I do not wish to attest my vaccination status. I have received or will receive a negative PCR COVID-19 test within 72 hours of this event, or a rapid test within 8 hours of the event. I am prepared to show proof of a negative test at the time of the visit.

I do not wish to attest my vaccination status, but will wear a mask at all times indoors and will refrain from removing the mask for eating or drinking indoors.

I understand that if I test positive for COVID-19 while on the Princeton campus that I will be required to leave the campus. *

Yes

I understand that COVID-19 self administered antigen test kits will be available at the conference for my use in the case that I do not feel well. *

Yes

Visitor Expectations

Visitors must cancel their planned visit if they test positive for COVID-19 within ten (10)
days of the planned start of their visit, if they are experiencing symptoms consistent with
COVID-19, or if they were identified as a close contact of an individual who tested positive
within the last ten (10) days and have not had a negative COVID-19 test since the
exposure. Visitors must notify the sponsoring host if they test positive for COVID-19 within
five (5) days after their visit.

A copy of your responses will be emailed to the address you provided.

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