Vaccination Status Attestation

* indicates required field
 


 
For the purposes of this certification, you are considered “fully vaccinated” * if it has been at least 14 days since either the second dose in a two-dose COVID-19 vaccine series (e.g. Pfizer or Moderna), or a single-dose COVID-1 vaccine (e.g. Johnson & Johnson/Janssen). * Vaccines must be FDA approved; have an emergency use authorization from the FDA; or, for persons fully vaccinated outside the United States, be listed for emergency use by the World Health Organization (WHO). Please select the statement below that accurately describes your vaccination status:


 



 
 
By typing your full name below, you hereby affirm that you have accurately and truthfully completed this form.

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