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Covid-19 Vaccination Details
Name
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Date of Birth
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Are you Fully Vaccinated? Have you received two doses of a COVID-19 vaccination?
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Yes
No
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Date of First Dose
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Date of Second Dose
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If you haven't had the vaccination are you intending to get vaccinated against COVID-19 by the 15th of November 2021?
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Yes
No
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If you haven't had the vaccination do you have a COVID-19 vaccination exemption on medical grounds from a health professional?
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Yes
No
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