COVID-19 Vaccine Registration Form

Thank you for your interest in the COVID-19 vaccine.
As your stay in Kingdom of Bahrain exceeds three weeks you will be offered free access to one of the Kingdom’s approved vaccines (Pfizer-BioNTech Vaccine), subject to meeting the Kingdom’s minimum health requirements.

Your application will be reviewed and, if approved, you will be contacted via the BeAware application, SMS and Email with the date and location for the administration. Of your preferred vaccine (subject to availability).

CONSENT FORM FOR COVID-19 VACCINE AS AUTHORIZED BY THE KINGDOM OF BAHRAIN FOR EMERGENCY USE

I hereby acknowledge and accept that:

1. My participation in the administration of any available Covid-19 vaccine (the “COVID-19 Vaccine”) is voluntary.
2. I am aware that the level of effectiveness attainable by the COVID-19 Vaccine cannot be achieved with a single dose. Accordingly, I agree to follow the instructions of Bahrain's Ministry of Health regarding the administration of a second dose.
3. I understand that the two separate doses of my preferred vaccine must be administered twenty one (21) days apart. Therefore, I accept that if, for any reason, I am unable to receive the first dose of my preferred vaccine at least twenty one (21) days before my scheduled departure from Bahrain, I forfeit my right to receive either dose of my preferred vaccine.
4. That the COVID-19 Vaccine is not interchangeable with other vaccines designed to combat COVID-19 and that both doses required in the vaccination must be from the same manufacturer.
5. The use of the COVID-19 Vaccine may cause side effects, including but not limited to pain, tenderness, redness, induration and pruritus at the vaccination site; systemic reactions including fever, headache, fatigue, nausea, vomiting, diarrhea, cough, allergy, muscle pain, arthralgia, lethargy, and convulsion. If I experience any of these or other moderate to severe symptoms, I will consult a doctor immediately.
6. The COVID-19 Vaccine has been approved for emergency use by Bahrain's National Health Regulatory Authority.
7. I release and discharge Bahrain's Ministry of Health and National Health Regulatory Authority from all and any liability arising out of or in connection with the administration of the COVID-19 Vaccine to the extent permitted by the laws of the Kingdom of Bahrain.
8. The administration of the COVID-19 Vaccine does not eliminate the possibility of infection with COVID-19. Therefore, I will continue to abide by the preventive measures published by Bahrain's Ministry of Health with respect to COVID-19, after the administration of the COVID-19 Vaccine.
9. You will be contacted with vaccination date and location via SMS, Email and BeAware App (Please make sure you download the app and register with the same information registered in this form).
10. The information disclosed herein shall be confidential.

By submitting this application, I affirm that the facts set forth in it are true and complete, and agree with the above mentioned terms, conditions and consent.