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Student Vaccination Card Upload

District Clay Mandatory Vaccination Survey

Use this survey only if you are a current DCC student.  (DCC artists should use this alternate link.)

All information is strictly confidential and will not be shared.  Once your vaccine card is verified, it will be deleted by District Clay. 

As of September 8th, all renewing and new students, artists, and workshop attendees must complete this survey to continue to use District Clay's space.  A very limited number of exceptions are allowed (see below.) 

(For members of our kids classes, the name of the child enrolled in the class and the parent's email should be recorded)

Once you complete this registration, you will not have to do it again.
1. Please identify yourself: *This question is required.
2. I am a: *This question is required.
3. Whose class are you taking? *This question is required.
3. What is your vaccination status as of today? *This question is required.
4. PLease let us if you have a valid medical reason as determined by the CDC that you are not vaccinated:

Valid medical reasons are:   a severe allergic reaction to a previous COVID-19 shot or a known severe allergy to an ingredient in a vaccine AND you have been advised by a doctor not to get an alternate vaccine

The CDC describes a several allergic reaction as: a person needs to be treated with epinephrine or EpiPen© or if the person must go to the hospital.  Please note an immediate allergic reaction that includes hives, swelling, and wheezing is not a severe reaction. 

People with an allergic reaction to one vaccine or to an ingredient in a vaccine are often advised to take a different vaccine.  Different vaccines utilize difference ingredients (Johnson:  polysorbate; Pfizer/MOderna: PEG).

For more information from the CDC on allergic reactions and ingredients in COVID-19 vaccines, go here. *This question is required.
4. Please upload a copy of the front of your vaccination card.  Your registration is not complete until you upload your card. *This question is required.