V2U Campaign - Vaccination Camp Interest Form

In order to fully vaccinate the eligible classes of citizens of the District Amritsar and put an end to fight against invisible enemy. District Amritsar has envisaged "Vaccine to You" (V2U) Campaign.

Under this campaign the District Administration would directly reach out to the citizen collectives like societies, clubs, corporate organizations, welfare associations, religious institutions, NGOs and various other civil society organizations to organize a vaccination camp at the location of their choice provided that it has the all the necessary provisions to carry out CoVID- 19 Vaccination drive safely.

The Administration encourages the citizens collectives and leaders to come forward and get as many people vaccinated as possible.

#Amritsarfightscorona
#V2Ucampaign
#CoVID19Vaccines
#Asrfightstogether

For more verified information, please log on to amritsar.nic.in
Sign in to Google to save your progress. Learn more
Important:
All interested organizations/citizens collectives/community leaders should note that all the details laid down below are absolutely necessary for setting up of a vaccination camp at the venue. Lack of any single element would lead to cancellation of scheduled vaccination drive.

1. The sole responsibility of setting up vaccination camp and crowd management rests with the organizer.

2. It must be ensured by the organizers that CoVID-19 protocols are followed at the venue. Citizens should follow the guidelines on the CoVID appropriate behaviors.

3. It should also be noted that all the Vaccines shall be administered only to citizens aged above 18 years upon the production of valid ID proof.

4. The minimum number of citizens for setting up a vaccination camp under V2U campaign is 50. The organizers shall provide the list of interested citizens before hand in the the suggested format.

5. In case of any  query or confusion, the decision of the vaccination team on the site shall be final and binding.

In case of any query or clarification: Drop a mail on covidmanagementcellasr@gmail.com
Name of the Organization/Citizen Collective/Community Leader *
Contact Number of the organization/Citizen Collective/Community Leader *
Name of the Point of Contact (PoC) [ Note: This person will act as a mediator between the health department and the organization/citizen collective] *
Mobile Number of the PoC *
Number of interested eligible citizens for vaccination *
Location/Venue for Vaccination *
Preferred Date of the Vaccination Camp? *
MM
/
DD
/
YYYY
Preferred time slot for Vaccination Camp? *
Does the venue has proper space for social distancing of mentioned strength of the people? *
Does the venue has a separate room/space for vaccination of people? *
Does the venue has a post-vaccination observation room/space for vaccinated people? *
Does the venue has a properly ventilated waiting area for the mentioned strength of people? *
I on behalf of the said organization/citizen collective, certify that the information furnished above has been verified and checked for it's authenticity. I understand that lack of any element mentioned above would lead to the cancellation of the scheduled vaccination camp. I also understand that I solely bear the responsibility for the organization of the camp and proper crowd management. I also certify that proper provisions for CoVID - 19 protocols will be ensured at the specified venue. *
Required
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms