Disney - Vaccine Validation

Disney - Vaccine Validation

If you are seeking an exemption please follow up with employee relations and your health and safety manager.
Patient Form*
Practice Code*
Today's Date*

MonthDayYear
Date
Consent Form*
Production Name
Legal First Name*
Legal Last Name*
Nickname / Stage name
Date of Birth*

MonthDayYear
Date
Gender*
Email*
example@example.com
Alternate Email
example@example.com
Mobile Phone Number*
Please enter a valid phone number.
Home Address*

Street Address

Street Address Line 2

CityState

Zip Code
Are you completing this form on behalf of a Minor?*

NoYes
Your Role*
Perner Number
Within the past 10 days, have you experienced any of the below symptoms that cannot be attributed to another health condition? Fever or chills fatigue, muscle or body aches, new loss of taste or smell, congestion or runny nose, cough, shortness of breath or trouble breathing, headache, sore throat, nausea, vomiting, or diarrhea*

YesNo
Have you been diagnosed with COVID-19 and not yet been cleared to end isolation?*

YesNo
Have you traveled internationally within the past 2 weeks?*

YesNo
You are not eligible to participate in GMA Gives Back because you have answered "Yes" to one of the above questions.

Vaccine Validation

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Vaccination status is being validated by a 3rd party to meet obligations set forth in the Return to Work Agreement and may affect the Health & Safety policies and protocols you follow.

In general, people are considered fully vaccinated:
- 2 weeks after their second dose in a 2-dose series, such as the Pfizer or Moderna vaccines, or
- 2 weeks after a single-dose vaccine, such as Johnson & Johnson’s Janssen vaccine.
Vaccination status is being validated by a 3rd party to meet obligations set forth in the Return to Work Agreement and may affect the Health & Safety policies and protocols you follow. Per the latest Return To Work Agreement, guidelines for vaccinations in Zone A have been revised from “fully vaccinated” to “up to date” on vaccination status. This update includes the requirement of booster shots. This guideline will apply to all crew working in Zone A.

In general, people are considered fully vaccinated:
- 2 weeks after their second dose in a 2-dose series, such as the Pfizer or Moderna vaccines, or
- 2 weeks after a single-dose vaccine, such as Johnson & Johnson’s Janssen vaccine.
If you don’t meet these requirements, regardless of your age, you are NOT fully vaccinated.
Fully Vaccinated - 2 weeks after final dose in primary series

Up To Date - A person is considered “boosted” and up to date right after getting their booster dose
If you are seeking an exemption please follow up with employee relations and your health and safety manager.
You can upload a photo of a negative COVID PCR test result within 2 days prior to the event, or a rapid result within 1 day prior.

If you are submitting a PCR test please select "I am fully vaccinated against COVID-19. Please upload your a photo of your negative test result in the field "Front and Back of Vaccine Card".
Please Select your Vaccination Status*

I am vaccinated against COVID-19.I am not currently vaccinated against COVID-19.
Legal Name (as shown on vaccine card)*

First NameLast Name
If you have a vaccination that is not listed, please reach out to employee relations and your health and safety manager for an accommodation.
Type of First Vaccine*
Date of First Vaccination*

MonthDayYear
Date
Type of Second Vaccine
Date of Second Vaccination

MonthDayYear
Date
Date You Will Receive Second Vaccination?

MonthDayYear
Date
Type of First Booster Vaccine
Date of First Booster Vaccination

MonthDayYear
Date
Front of Vaccine Card(s) - You can upload multiple files*

You can upload multiple files.
Cancelof
Not Vaccinated Override*
Should be Empty:

Disney - Vaccine Validation

You are not eligible to participate in GMA Gives Back because you have answered "Yes" to one of the above questions.

Vaccine Validation

You can upload a photo of a negative COVID PCR test result within 2 days prior to the event, or a rapid result within 1 day prior.