Vaccination Status 会友疫苗调查问卷
Please take a few minutes to inform us of your vaccination status. The completion of this update is optional, but encouraged as the data collected will help JCC to plan for our upcoming services. Thank you. 请您参与这几分钟的调查。因疫情的影响,这调查能让教会更好的安排崇拜人数。这调查不是强制性。
Language Section 语言部
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English Congregation
中文堂
Name 姓名
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Contact 联络号码
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e.g. 91234567
Have you received the COVID-19 vaccination? 您已否接种冠病疫苗?
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Vaccinated (2 doses) 已接种两剂疫苗
Partially vaccinated (1 dose) 已接种第一剂疫苗
Exempted (due to medical condition) 不适宜接种疫苗(基于医疗原因)
Not vaccinated (other reasons) 未接种疫苗(其他原因)
Type of vaccine 疫苗类型
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Pfizer-BioNTech / Comirnaty
Moderna
Sinovac
Other
Date of First Dose 第一剂接种日期
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Day
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Month
Year
Date
Date of Second Dose 第二剂接种日期
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Day
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Month
Year
Date
Date of Second Dose 第二剂接种日期
*
/
Day
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Month
Year
Date
No second dose date 没有第二剂日期
Remarks 请注明原因
Submit 提交
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