Artist/Teacher Vaccination Card Upload

District Clay Mandatory Vaccination Survey

Use this survey only if you are a current DCC artist, teacher and work/study assistant.

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, work/study colleagues 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.)

Once you complete this registration, you will not have to do it again.

1. Please identify yourself: *This question is required.

First Name

Last Name

Email Address

2. What is your vaccination status as of today? *This question is required.

On what month/day will you be fully vaccinated (final shot plus two weeks)? Please continue with the survey and upload your vaccine card with your current shot notations.

NOTE: You will need to repeat this survey as soon as you are fully vaccinated and upload your completed vaccine card.
*This question is required.

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.

Please enter an 'other' value for this selection.

3. Please upload a copy of the front of your vaccination card.

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