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Enter a one or two word description of who you are. For example, you could write "Teacher", "Community Member", "Business Owner", or "Nurse".
Enter a brief sentence explaining why you decided to get vaccinated.
By submitting this form, I'm verifying that I understand that photographs, digital, or other images will be recorded to document Public Health initiatives. I consent to this. I further understand that Schuyler County Public Health will retain the ownership rights to these photographs, digital, or other images. If I request a copy, then Schuyler County Public Health will provide me with a digital copy. By submitting this form, I authorize Schuyler County Public Health to use any photos that include a picture of me for the use of promotions / advertisements / press releases for Public Health initiatives and I understand the photos may appear on a web page, newsprint, pamphlet or brochure.
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