COVID-19 Vaccination Status

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In order to reduce contact tracing and unnecessary phone calls, we are asking parents to provide the COVID-19 vaccination status of your children. This is CONFIDENTIAL and will only be used by the nurses and office staff for the above mentioned reasons. While this is OPTIONAL, we are hoping that you would be willing to provide this information so that we can keep our school community healthy in an efficient and professional manner. Please complete this form for each student in your household. This form can also be found under "quick links" on the SJA website for continual updating as your children become vaccinated.

Last Name

First name

Homeroom/Grade

Has your child received a COVID-19 Vaccination?

Yes, one dose.

Yes, two doses.

Yes, two doses + booster.

I would prefer not to answer.

No. (If No, please see next question)

Not eligible

Clear selection

My child is not vaccinated, had COVID, and is exempt from quarantine for 90 days as long as symptom free from the date entered below.

Submit

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