AIKIDO OF MOUNTAIN VIEW - Proof of most recent Covid-19 Booster Vaccination for Minors

AIKIDO OF MOUNTAIN VIEW

1924 Plymouth St, Mountain View, CA 94043

Proof of most recent Covid-19 booster vaccination for Minors

This form is used by a parent or legally authorized guardian of a minor to submit proof of the most recent Covid-19 booster vaccination for MINORS who have previously submitted proof of vaccination and have a current waiver on file with AIKIDO OF MOUNTAIN VIEW.

(The name of the Minor is entered as "Participant's Name" below.)

I am the parent or legally authorized guardian of the Minor.

On behalf of the Minor, I am submitting proof of the most recent Covid-19 Booster Vaccination received by the minor.

Signee Information

First Name *

Last Name *

Your Date of Birth *

Phone *

Email Address *

Address *

Address Line 2

City *

State *

Zip *

Please enter participants' full names:

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Adding proof of most recent Covid-19 booster vaccination - for Adults and Minors with waivers already on file *

Proof of most recent booster dose must be provided for all Adults and Minors who are eligible for a booster vaccination. PDF, jpg, png or gif

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By clicking 'I Agree' below, you agree that you have read and agree with the terms of the waiver and that the information you provided is accurate. You furthermore agree that your submission of this form, via the 'I Agree' button, shall constitute the execution of this document in exactly the same manner as if you had signed, by hand, a paper version of this agreement.