JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
2022 AWC COVID19 Vaccination Data
NYS requires all licensed Children's Summer Camps to collect and keep this data for Department of Health review.
Once you have completed this form, send an image or copy of the vaccination record to
info@woodcraftcamps.com
.
Many thanks!
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Last Name
*
Your answer
First Name
*
Your answer
Vaccination Status
*
Unvaccinated
Fully Vaccinated (has received all recommended doses in the primary series of COVID-19 vaccine)
Up to Date (fully vaccinated AND a booster dose if eligible)
Date of First Immunization Dose (month, day, year)
*
Your answer
Date of Second Immunization Dose (month, day, year)
*
Your answer
Date of Booster (month, day, year)
*
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Adirondack Woodcraft Camps.
Report Abuse
Forms
