COVID Applications - Self Registration Form

Please fill out this form before arriving for your first COVID-19 test at Hamilton College.

You DO NOT need to complete this form if:

You are a Hamilton College employee or student.
You have already completed this form at a previous visit.
You have been tested previously in the Hamilton College testing center.

First Name:

This should be legal first name, not a nickname or chosen name.

Middle Name:

Last Name:

Mobile Phone Number:

Be sure to include area code, format xxx-xxx-xxxx.

Email Address:

Date of Birth:

Gender

Race

Ethnicity

Relationship to College

Home Address:

City:

State:

Zip:

County

HAMILTON COLLEGE COVID-19 VACCINE ATTESTATION AND TESTING CONSENT

Vaccine Attestation

Individuals participating in sports camps or clinics conducted on the Hamilton College campus during summer 2022 are required to be fully vaccinated and, if eligible, boosted with an approved COVID-19 vaccine prior to participation (absent an approved accommodation). For purposes of this requirement, full vaccination means that two or more weeks have passed since an individual received the final dose of any vaccine approved by the FDA or authorized by the FDA for emergency use in the U.S. (currently the first dose for Janssen/Johnson & Johnson, or the second dose for Pfizer and Moderna), as well as any approved booster doses, if eligible: get boosted 5 months following the completion of an initial mRNA vaccination series or 2 months after receiving an initial J&J vaccination. By signing below, the undersigned confirms, represents and attests that the individual identified below (the "Participant") has been fully vaccinated and, if eligible, boosted, within the meaning of this paragraph, and agrees to provide proof of such vaccination if requested by Hamilton College.

Participant Name:

(full name)

Parent/Guardian Signature:

Type your FULL NAME in this box to indicate signature of the vaccine attestation and testing consent agreement above.

HAMILTON COLLEGE COVID-19 VACCINE ATTESTATION AND TESTING CONSENT

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