Vaccination Card Upload
I am a:
*
Company Dancer
Teaching Faculty or Accompanist
Pro / Launch Trainee
Staff Member
Visiting Artist or Guest
Participant in ____
Name:
*
First Name
Last Name
Email:
*
example@example.com
Phone Number:
*
I am...
Uploading an UPDATED vaccination record, after previously using this form to submit my vaccination record
Uploading my vaccination record for the Foundation/Company/Institute for the FIRST TIME
I am fully vaccinated:
*
Yes
No
I plan to be fully vaccinated within thirty (30) days from the initial date of hire:
*
Yes
No
Date of First Dose (scheduled or previous)
-
Month
-
Day
Year
Date
Date of Second Dose (scheduled or previous, if applicable)
-
Month
-
Day
Year
Date
Date of Booster (scheduled or previous, if applicable)
*
-
Month
-
Day
Year
Date
Covid-19 Vaccination Card (front):
*
Browse Files
Drag and drop files here
Choose a file
Please Upload Your File
Cancel
of
Covid-19 Vaccination Card (back, if applicable):
Browse Files
Drag and drop files here
Choose a file
Please Upload Your File
Cancel
of
Verification
*
Submit
Should be Empty: