COVID-19 Vaccination Proof

Falls Church Soccer Association Employees, Coaches and Supporting Staff can submit their Proof of COVID-19 Vaccination via this form.

Once submitted, our FCSA VIRUS Committee will follow up with you directly to review and confirm approval.

Once Proof of COVID-19 Vaccination is approved, the FCSA employee, coach, or supporting staff member can participate in FCSA activities without a mask and is not required to maintain physical distance.

All information received will remain private and confidential.

You can view FCSA COVID-19 Policies and Protocols on the website.

The name and uploaded file associated with your account will be recorded.

* Required

Name

First

Last

Other Program

Type of vaccination shot (ie. Moderna, Pfizer, Johnson & Johnson or other):

Date of final vaccination shot:

Additional notes for consideration:

Please upload your proof of vaccination. (accepted format of submission includes a photo of your vaccine card)

Maximum upload size: 516MB

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