COVID-19 Vaccination Cards Form

First Name

Last Name

Email Address

Phone Number

Date of Birth

Are you an employee or a student?

Employee

Student

Student Number

Employee Number

Attachment (vaccination card)

One file only.
256 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods.

Attachment (medical records)

One file only.
256 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods.

Attachment (covid tests results)

One file only.
256 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods.