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2021 MINNESOTA VIKINGS COVID-19 VACCINE CERTIFICATION

Effective immediately, fully-vaccinated media members will not be required to wear masks anywhere at TCO Performance Center, either indoors or outdoors. An individual is considered “fully vaccinated” if 14 days have passed since the individual received his or her last dose of a COVID-19 vaccine (either the single dose of Johnson & Johnson or the second dose of Pfizer or Moderna). Media who are not fully vaccinated (i.e., have not received any vaccine, or are within the 14-day period after receipt of the last dose of the vaccine) must continue to wear masks indoors and outdoors at the club facility.

Minnesota Vikings Football, LLC (“Club”) encourages all of its employees, contractors, vendors and media members to receive a COVID-19 vaccine as soon as possible based upon the availability of the vaccine and vaccination eligibility guidelines. Future participation in Club events, travel, or similar activities may be dependent on vaccination status, subject to applicable law, and personnel whose vaccination status has been verified may be eligible for less restrictive protocols and quarantine requirements.

The National Football League (“NFL”) and the Club are asking that all employees, contractors, vendors and media members who will have or may have personal contact with NFL players and staff to be fully vaccinated and to provide verification of that vaccination.

If you are a Club employee, contractor, vendor or media member and have received a COVID-19 vaccine, you should complete this form. You are not required to provide any documentation related to your vaccination or any medical or genetic information as part of the certification process. If you do not complete this form, you are indicating that you have not been vaccinated for COVID-19.

Your information will only be used in our efforts to promote a safe workplace and will be treated as confidential information.

Because applicable protocols and guidance may vary based on the date an individual was fully vaccinated, we ask that you provide your date of full vaccination as set forth below.

If you received a two-dose vaccine (Pfizer or Moderna), your date of full vaccination is fourteen (14) days after the date you received your second dose. If you received a single-dose vaccine (Johnson & Johnson), your date of full vaccination is fourteen (14) days after the date you received the single dose.

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Parent or Guardian's Email Address

Email*

Confirm Email*
Vaccination Information
Type of Vaccination

Date of Full Vaccination (14 days after you received the single dose of Johnson & Johnson or 14 days after you received the second dose of Pfizer or Moderna)
If not fully vaccinated, please select what applies to your current status
In the process to receive a second dose of Pfizer or Moderna
Received a single dose of Johnson & Johnson or two (2) doses of Pfizer or Moderna but yet to complete your 14-day waiting period?
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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