Vaccination Status 2021

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This fall, Circle Yoga is requiring all students taking in-person classes to be fully vaccinated for Covid-19. Before coming to class, please complete the fields below to certify your vaccination status and to ensure that the emergency contact information we have on file for you is current. Each student needs to submit this form only once.

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* Indicates required question

Are you fully vaccinated against Covid-19? *

Yes

No

Student First Name *

Your answer

Student Last Name *

Your answer

Student Email Address *

Your answer

Emergency Contact Name (first and last) *

Your answer

Emergency Contact Phone Number *

Your answer

Today's Date *

MM

/

DD

/

YYYY

Submit

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