Times Squares Waiver of Liability & Proof of Vaccination Upload Form
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Date
Upload Photo(s) of Proof of Vaccination
*
Browse Files
Drag and drop files here
Choose a file
This can be a jpg, png, or pdf file of your COVID-19 vaccination record. Your name and date(s) of vaccination shot(s) received should be visible and legible.
Cancel
of
Waiver of Liability: Please check each of the boxes below to indicate that you have read and agree with the following statements.
*
Signature
*
Submit
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