St. Francis Xavier CHS - Hammond Essential Visitor COVID-19 Vaccination Attestation
Essential Visitors, Volunteers, Third Party Contractors & Other individuals must be fully vaccinated against COVID-19 in order to access the school/building (fully vaccinated against COVID-19 means the individual has received two doses of a two-dose vaccine; and having received the final vaccine dose at least 14 days ago) . Individuals that are not fully vaccinated are not permitted to access the school/building at this time.
Name
First Name
Last Name
1.Please select from the list below the category that best represents who you are.
Parent/Guardian
Volunteer
Contingency List Supply (unqualified)
Third=Party Contractor
Student on Educational Placement
Providing Professional Services to Students
Other (i.e. Parish Priest, Catholic School Council Member, etc.)
Email
example@example.com
Phone Number
Please enter a valid phone number.
Vaccination Status:
I am fully vaccinated.
I am fully vaccinated and received a booster dose.
Upload the receipt of first vaccine doseUpload the vaccine receipt #1 below. Receipt should be uploaded as follows - LASTNAME, FIRSTNAME-Dose 1Upload
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Upload the receipt of second vaccine doseUpload the vaccine receipt #2 below. Receipt should be uploaded as follows - LASTNAME, FIRSTNAME-Dose 2
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Upload the receipt of the vaccine booster below. Receipt should be uploaded as follows - LASTNAME, FIRSTNAME-Booster
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Submit
Should be Empty: