Covid-19 Vaccination Status Form - Cincinnati Youth Collaborative

COVID-19 Vaccination Status Form

First and Last Name

CYC Email Address

Have you had your first COVID vaccination?

Have you had your second COVID vaccination?

Please upload a copy of your vaccination card.

Are you requesting an exemption?

Please upload documentation supporting your exemption request.

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301 Oak Street | Cincinnati, OH | 45219 | 513-363-5200