Vaccination Document Upload Form 

Prior to enrolling in a JVS program, all clients must provide official documentation of vaccination that includes the name of the COVID-19 vaccine you received and the dates you were vaccinated. This documentation may include your CDC Vaccination Card, World Health Organization Yellow Book, or official documentation from a medical provider. 

Proof of COVID-19 vaccination is reviewed by internal JVS staff upon submission. Submitting a fake or tampered with COVID-19 vaccination proof may be grounds for denial of services or removal from program.
Your proof of COVID-19 vaccination information will be used internally to prevent and respond to the presence of COVID-19 at JVS and to comply with federal, local and public health guidelines. Your information will be maintained in accordance with our confidentiality protocols and in accordance with all applicable laws and public health regulations. 

If you have lost your vaccine card, everyone who is vaccinated in California can request a digital COVID-19 Vaccination Record at My Vaccine Record.

Medical exemption and religious exemption requests will be considered. If you would like to be considered for a COVID-19 vaccination exemption, please complete one of the following forms:

If you have any questions about JVS’s COVID-19 protocol please visit our FAQ at JVS Client Resources or contact us at for assistance.