Skate Like a Girl Staff and Volunteer Vaccination Records

Pursuant to CDC guidelines, federal, state, and local laws and regulations, as well as our partners, Skate Like a Girl must document vaccination status of all employees and volunteers. In compliance with this requirement, please complete this form. This information will be kept confidential in Human Resources. Please provide accurate information about your vaccination status below. For purpose of this certification, you are considered “fully vaccinated” two weeks after completing the second dose of a two-dose COVID-19 vaccine (e.g. Pfizer or Moderna) or two weeks after receiving a single dose of a one-dose vaccine (e.g., Johnson & Johnson/Janssen). If you are not fully vaccinated because of a medical condition or disability or strongly held religious belief that prevents you from receiving the vaccine, please ensure to read through the complete policy & step-by-step instructions linked here.

Name*

First NameLast Name

E-mail*

Confirmation Email

Primary role with Skate Like a Girl*

My vaccination status*

Date of Final Shot

Date

Date of Next Shot

Date

Date of Scheduled First Shot

Date

Skate Like a Girl Vaccination Policy for Volunteers and Staff

I hereby certify that, to the best of my knowledge, the provided information is true and accurate. Sign below that you have read and acknowledge the Skate Like a Girl Vaccination policy:

Upload photo of your vax card and/or other form of record*

Upload a File

Please upload a document where we can see your full name & date(s) of shot(s)

Comments

Skate Like a Girl Staff, Volunteer, & Contractor Vaccination Policy Acknowledgement