By completing this form, I am declaring that I am unable to be vaccinated for COVID-19 on the basis of Medical Disability / Accommodation.
I have a medical condition or disability that prevents me from being able to take any COVID-19 vaccine. NOTE: To be eligible for this exemption, I understand that I must also provide to US Squash a written statement signed by a physician, nurse practitioner, or other licensed medical professional practicing under the license of a physician, stating that I qualify for the exemption and indicating the probable duration of my inability to receive the vaccine (or if the duration is unknown or permanent, so indicate).