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COVID-19 Vaccination Record

Please complete the form below. Required fields marked with an asterisk *

The Oakland Unified School District Board of Education passed a policy that all students ages 12 and up are required to receive COVID-19 vaccines and to be fully vaccinated by January 31, 2022. This policy applies to all charter schools that operate on district owned property or seek to have their students participate in Oakland Athletic League (OAL) activities or against OAL teams. For more information on the Student Vaccine Mandate Policy please see the following links:

OUSD Board Policy https://drive.google.com/file/d/1HrRqbTWV0D0Un8AD7qRRVfwUti5bVQJ8/view?usp=sharing
Student Vaccine Mandate Policy - Implications for Charter Schools https://drive.google.com/file/d/1yqpenPm5aYfZqqOdZqI92YhfrJ0Ij8HY/view?usp=sharing
EXEMPTION FORM (English) https://drive.google.com/file/d/1d9tChnJ5y0LnEVmlXjH-eST-Md3CBxY3/view?usp=sharing
EXEMPTION FORM (Spanish) https://drive.google.com/file/d/13P_IKDHP_z9Pz92GQENZWhzm84Eq2jFC/view?usp=sharing

**If you are completing an exemption form please submit it at the front office.**

Contact Information
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Please upload a clear picture/scan of your student's COVID-19 Vaccination Record*
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