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Student Vaccination Status
* Indicates required question
Email
*
Your email
Name
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Age
Your answer
Sex
*
Your answer
Contact No
*
Your answer
Roll No
*
Your answer
Are you taking any chronic medication for any disease including psychiatric disease?
*
Yes
No
If yes (chronic medication for any disease including psychiatric disease), please specify
Your answer
Are you vaccinated
*
Yes
No
Vaccine Name
Your answer
Date of 1st Dose
MM
/
DD
/
YYYY
Due Date/Vaccinated Date of Second Dose
MM
/
DD
/
YYYY
Date of Arrival
*
MM
/
DD
/
YYYY
Mode of Transport
Your answer
Train No
Your answer
Time of Arrival
Time
:
AM
PM
Arriving Station
Your answer
Remark
Your answer
Submit
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