MSOS Student COVID-19 Vaccination record

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

If your child has been fully vaccinated OR is in the process and has had at least one COVID-19 vaccine dose please fill out the below form for your child's school health record. After completing the form if your child has had BOTH doses please email a copy of your child's COVID-19 vaccination record card to mvallesteros@starofthesea.org. Please note the completion of this form in voluntary.

Student Name *

Student Home Room *

Parent name *

Parent email *

Has your child received their COVID-19 vaccination first dose? *

Yes

Has your child received their COVID-19 Vaccination second dose? *

Yes

Has your child been scheduled to receive their first COVID-19 vaccination dose, and will receive it with in the next 2 months?

Yes

Not applicable

Clear selection

Did your child receive their COVID-19 vaccination at the Mary, Star of the Sea School vaccination clinic's?

Yes

Clear selection

Thank you for completing this form. If your child has received both first and second dose of their COVID-19 vaccination please email a photo of their card to mvallesteros@starofthesea.org OR drop a copy off to the MSOS front office. Mahalo!

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Star of the Sea School. Report Abuse

Forms