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COVID-19 Vaccination Record

Please complete the below form once for every vaccinated Shorewood student in your household. Thank you!

Student's First Name*

Answer Required

Student's Last Name*

Answer Required

Student's Date of Birth:*

Answer Required

Student's School*

Answer Required

Lake Bluff Elementary

Atwater Elementary

SIS

SHS/New Horizons

Guardian's Preferred Email Address:*

Answer Required

Upload legal vaccination record here. Legal records can be a photo of the COVID-19 vaccination card, PDF from a physician's office or the WIR, or a certified letter from the State or Local Health Dept. A handwritten or typed note with dates on it will NOT be accepted.*

Answer Required

Choose a file or drag it here.