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COVID Vaccination Survey / Encuesta de Vacuna de COVID - William Orr
COVID Vaccination Survey / Encuesta de Vacuna de COVID - William Orr
Please complete the form below. Required fields marked with an asterisk *
Student's First Name/Nombre del estudiante
*
Answer Required
Student's Last Name/Apellido del estudiante
*
Answer Required
Date of Birth/Fecha de nacimiento
*
Answer Required
My child is fully vaccinated (dose 1 and 2) for COVID. If yes, you will be asked to upload proof at the end of this survey or you can opt to take a copy to your child's school office. / Mi hijo/a está completamente vacunado (dosis 1 y 2) contra COVID. En caso afirmativo, se le pedirá que cargue una prueba al final de esta encuesta o puede optar por llevar una copia a la oficina de la escuela de su hijo/a.
*
Answer Required
Yes/Si
No
My child tested positive for COVID within the last 90 days. / Mi hijo/a dio positivo por COVID en los últimos 90 días.
*
Answer Required
Yes/Si
No
If your child tested positive for COVID within the last 90 days, please let us know the date of the positive test result. / Si su hijo dio positivo por COVID en los últimos 90 días, infórmenos la fecha del resultado positivo de la prueba.
Answer Required
My child is registered for the weekly LLCSD COVID testing. / Mi hijo está registrado para la prueba semanal LLCSD COVID.
*
Answer Required
Yes/Si
No
Please upload your child's proof/picture of vaccination here. Por favor, suba la prueba / foto de vacunación de su hijo aquí.
*
Answer Required
Choose a file
or drag it here.
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