COVID Vaccination Student Status

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Dear Families,

Our goal is to sustain in-person learning for the 2021-2022 school year within the guidelines of the Illinois Department of Public Health and the Illinois State Board of Education.

To assist us in this effort, students and staff are working together to verify vaccination status. Please complete or update the survey to provide vaccination information for your child (5 and older ) who is eligible to be vaccinated. Thank you for your partnership to support a healthy school community.

Email *

What is your last name? *

What is your first name?

What is your email address?

What is your telephone number?

What is your child's first name? *

What is your child's last name? *

Your child is a student at what school?

Algonquin Pre-Kindergarten Center

21st Century Primary School

Blackhawk Primary School

Mohawk Primary School

Barack Obama School of Leadership and STEM

Michelle Obama School of Technology and the Arts

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The child named above is fully vaccinated *

Yes

If fully vaccinated, the date of the final vaccination was ?

YYYY

If not fully vaccinated, when will the individual complete his/her vaccination?

YYYY

Send me a copy of my responses.

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