Student COVID-19 Vaccination Information Form

As per Executive Order 253, the District would like to collect COVID-19 vaccination information from all students who have been vaccinated.   The vaccination information will be kept as confidential records in the nurse's office and will only be used for purposes of close contact tracing, as students will not be required to quarantine if they are vaccinated.  If your child has been vaccinated please use the link to complete the form in which you will be asked to upload vaccination documentation.  


The following COVID-19 documentation is acceptable:

-CDC COVID-19 Vaccination Card, or an electronic or physical copy of same;

-Official record from the New Jersey Immunization Information System or other State registry;

-A record from a health care provider's portal/medical record system on official letterhead, signed by a licensed physician, nurse practitioner, physician's assistant, registered nurse or pharmacist;

-Docket mobile phone application record or any state specific application that produces a digital health record.


For Willow Grove School:

WG: Student COVID-19 Vaccination Information Form


Please do not hesitate to call the school nurse if you have any questions or concerns.  We greatly appreciate your cooperation