Haldane Student Vaccination Status

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Haldane Student Vaccination Status - 2021-2022

Completion of this form is voluntary.

Please wait until your child has received both doses before completing this form.

If you would like to report your child's vaccination status to Haldane, please complete this form. This information will be kept confidential and will only be used by Administrative staff for contract tracing purposes.

Student Last Name *

Student First Name *

Student Grade Level *

Student's Vaccination Status - please wait until your child has receive both doses before completing this form. *

Fully Vaccinated - 2 doses

Unvaccinated

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