Vaccination Information 2021 (Mooretown Lady Flags)

Vaccination Information 2021

Please fill out all sections & upload either a screen shot or scan of your proof of 2nd COVID vaccine. Your records will be kept confidential and only the Mooretown Lady Flagsrep collecting will have access to them.

Information

First Name^*

Required

Last Name^*

Required

DOB^*

Required

Email Address^*

Required

Example: [email protected]. Your submission will be sent to this address.

Lady Flags Position

Please use the drop down menu to identify as either a player, executive member or pick the appropriate age group (coach, manager, trainer etc)

Position^*

Required

1st Vaccine Info

Please enter the date of your first vaccine.

Date of 1st Vaccine^*

Required

Proof of 2nd Vaccine

Please upload your proof of 2nd vaccine. This information is kept confidential & not shared with anyone other than the person collecting on behalf of Mooretown Lady Flags.

Upload Proof of 2nd Vaccine^*

Allowed extensions: .jpeg, .jpg, .png, .gif, .pdf, .doc, .docx, .xls, .xlsx, .ppt, .pptx.
Maximum # Files: 1. Maximum File Size: 4MB.

Vaccination Information 2021 (Mooretown Lady Flags)

Information

Lady Flags Position

1st Vaccine Info

Proof of 2nd Vaccine

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