Voluntary Verification of COVID-19 Vaccination Form
In order to remain open and in-person as much as possible during the 2021-2022 School Year and to limit the number of potential quarantines that may be ordered by Public Health, Herkimer BOCES is asking you to let us know if your child has received a COVID-19 vaccine by filling out this form.

If your child is exposed to a confirmed, positive case of COVID-19 at BOCES this year and they are fully vaccinated, they probably won't have to be quarantined, as long as they are not showing any symptoms. Having this information ahead of time helps us work with Public Health and could result in less time out of school for your child.

This information is being collected as anonymously as possible, and does not mean that any student or employee is required to receive any COVID-19 Vaccine.
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Email *
Student's First Name *
Student's Last Name *
Date of Birth *
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Date of First Vaccination *
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YYYY
Date of Your Second Vaccination (only needed with Pfizer & Moderna Vaccines)
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Manufacturer of Vaccination *
By filling in your name below, you attest that to the best of your knowledge the information provided above is accurate. *
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