Vermont Law School

VLS COVID-19 VACCINE VERIFICATION

FOR RETURNING ALUMNI AND REUNION GUESTS


Thank you for confirming your Covid-19 vaccination status, and that of your intended guests. Please fill out the information below to submit all vaccine details. This information is collected securely and will never be shared with third parties.

All guests must be fully vaccinated before coming to campus. VLS defines fully vaccinated as boosted when eligible. If someone has had both shots (or 1 for Johnson & Johnson) and is 14 days out, they are fully vaccinated. Once they are eligible for a booster at 5 months for Pfizer or Moderna, or 2 months for Johnson & Johnson, they must get boosted to be fully vaccinated.



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Your Information

First Name: *
Middle Name:
Last Name: *
Email Address: *
Phone: *
Vaccine 1 Type: *
Vaccine 1 Date: *
Vaccine 2 Type:
Vaccine 2 Date:
Booster Type:
Booster Date:
Your Vaccine Card: * Upload Card Image Here:
(Accepted formats are PDF, PNG, and JPG.)

Your Guests' Information

Guest 1 First Name:
Guest 1 Last Name:
Guest 1 Email:
Guest 1 Phone Number:
Vaccine 1 Type:
Vaccine 1 Date:
Vaccine 2 Type:
Vaccine 2 Date:
Booster Type:
Booster Date:
Guest 1 Vaccine Card: Upload Card Image Here:
(Accepted formats include PDF, PNG, and JPG.)
Guest 2 First Name:
Guest 2 Last Name:
Guest 2 Email:
Guest 2 Phone Number:
Vaccine 1 Type:
Vaccine 1 Date:
Vaccine 2 Type:
Vaccine 2 Date:
Booster Type:
Booster Date:
Guest 2 Vaccine Card: Upload Card Image Here:
(Accepted formats include PDF, PNG, and JPG.)
Guest 3 First Name:
Guest 3 Last Name:
Guest 3 Email:
Guest 3 Phone Number:
Vaccine 1 Type:
Vaccine 1 Date:
Vaccine 2 Type:
Vaccine 2 Date:
Booster Type:
Booster Date:
Guest 3 Vaccine Card: Upload Card Image Here:
(Accepted formats include PDF, PNG, and JPG.)
Guest 4 First Name:
Guest 4 Last Name:
Guest 4 Email:
Guest 4 Phone Number:
Vaccine 1 Type:
Vaccine 1 Date:
Vaccine 2 Type:
Vaccine 2 Date:
Booster Type:
Booster Date:
Guest 4 Vaccine Card: Upload Card Image Here:
(Accepted formats include PDF, PNG, and JPG.)
Guest 5 First Name:
Guest 5 Last Name:
Guest 5 Email:
Guest 5 Phone Number:
Vaccine 1 Type:
Vaccine 1 Date:
Vaccine 2 Type:
Vaccine 2 Date:
Booster Type:
Booster Date:
Guest 5 Vaccine Card: Upload Card Image Here:
(Accepted formats include PDF, PNG, and JPG.)
Comments:
Information Collection Disclosure:

The information you enter here is used by VLS for verification purposes only, and the raw data (i.e., information on your vaccination status and your vaccination card(s)) will not be shared with any third party. Once your vaccination status is verified, and the event has concluded, the raw data will be destroyed. All data is collected and retained via secure protocols.
European Union residents, click here to request removal of your data from our systems.

*    Please check this box to indicate that you understand the data retention policy information.