COVID-19 CDC Vaccine Record Card Form

Per Executive Order number 2021-509, the Puerto Rican government has determined that it is safe for students, faculty, and staff to return to classes this August on the condition that all students aged 12 or older, faculty and staff are vaccinated and continue to adhere to other safety protocols outlined by each school. Medical or religious exemptions to the vaccination mandate require a written recommendation from the individual's doctor, pastor, or priest and notarized signatures of all parties. We ask that all families upload a copy of their child(ren)'s official vaccination card(s) on the TASIS Dorado Health Center webpage prior to the start of school.

LAST Namerequired

FIRST Namerequired

EMAIL to send confirmationrequired

DATE OF BIRTHrequired (mm/dd/yyyy)

GRADE required

ACADEMIC YEAR 2021-22

VACCINE ADMINISTERED

DATE OF 1st DOSE (mm/dd/yyyy)

DATE OF 2nd DOSE (mm/dd/yyyy)

DATE OF 3rd DOSE (mm/dd/yyyy)

UPLOAD VACCINE CARD

Take a photo of your CDC Vaccine Record Card and upload a legible copy here.

Max file size: 10 MB

OR UPLOAD EXEMPTION AFFIDAVIT (Medical or Religious)

Max file size: 10 MB

* IF YOU NEED TO UPLOAD THE SECOND DOSE AT A LATER DATE, YOU WILL NEED TO REPEAT YOUR SUBMISSION.

Please send a confirmation email to the address below: