Vaccine Verification Form
Effective Tuesday, September 7th, 2021 all individuals, 12 yrs and up, entering Kinected must show proof of vaccination of at least one dose of a COVID-19 vaccine authorized for emergency use by the FDA or WHO. This includes all Pilates clients, Physical Therapy patients, Kane School Students, Practitioners, Volunteers, and Kinected staff.
Proof of vaccination can be shown upon arrival to front desk staff or instructor or it is highly recommended to provide ahead of time by completing this survey. Vaccination status will be noted on file to be used for future visits, no images will be kept on file. Photo ID must also be shown upon arrival
Acceptable forms of vaccination include--
1)New York State Excelsior Pass App
2)New York State Excelsior Pass PDF
3)CDC vaccination card
4)International vaccination record of WHO authorized vaccine
If you do not wish to share proof of vaccination you will not be permitted on-site at this time and offered virtual options.
View our full vaccination policy at kinectedcenter.com and any questions can be sent to monica@kinectedcenter.com
Full Name
First Name
Last Name
Email
example@example.com
Next Kinected Appointment Date
-
Month
-
Day
Year
Date
Upload Proof of Vaccination
Browse Files
Drag and drop files here
Choose a file
Photo of CDC vaccination card, Excelsior App PDF
Cancel
of
Submit
Should be Empty: