COVID-19 Vaccination Card Upload Form
Full vaccination series only.
Students Name
*
First Name
Last Name
School Name
*
Collin Powell Middle School
Neil Armstrong Elementary School
Seiden Prairie Elementary School
Marya Yates Elementary School
Woodgate Elementary School
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Grade Level
*
Pre-K am
Pre-K pm
Pre-K All DAY
K
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
Front of Vaccination Card
*
Browse Files
Front
Cancel
of
Back of Vaccination Card
*
Browse Files
Back
Cancel
of
Vaccine Type
*
Johnson & Johnson
Moderna
Pfizer
Other
Number of doses received.
*
1 [Johnson and Johnson]
2
3
Submit
Should be Empty: