Covid Info | Rize CoWorking

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COVID-19 Vaccine Attestation

This form is provided so that members and guests of CoVort can attest to having received the COVID-19 Vaccination at least two weeks ago so they can move about the space without a mask.

First Name

Last Name

Email

By typing my name below, I certify that I have been fully vaccinated against COVID-19. Full vaccination means it has been two weeks since receiving both doses of either the Pfizer or Moderna vaccine, or after the single dose of the Johnson & Johnson vaccine.

Initials

Date

I declare that the info I’ve provided is accurate & complete

Thanks for submitting. Thank you! Enjoy your mask free working!

hello@rizemaine.com | (207) 814-7327 | 49 Main Street, Bangor, ME 04401

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