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Midvale
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Covid-19 Vaccination Declaration
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Fully Vaccinated : Received at least 2 doses of COVID-19 Vaccine, with last dose at least 14 days ago.
Masks Required: Not fully vaccinated, would rather not provide vaccination status
Optional, Please upload your vaccination record here.
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I declare that the info I’ve provided is accurate & complete. *Form only needs to be filled out once.
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