This registration is for any individual who is working or on-site in some capacity at the event on October 15. In order to participate, individuals are required to read, acknowledge, and provide the information requested below. For the purposes of this registration, “guest(s)” information applies to anyone working or on-site. By submitting this form, individuals acknowledge “signing.”

Attestation of Vaccination
In accordance with White House health and safety policies, and consistent with guidance from the Centers for Disease Control and Prevention (CDC), all guests should indicate if they are fully vaccinated. Guests who are unvaccinated, partially vaccinated, or who decline to indicate whether they are fully vaccinated will be required to (i) complete a COVID-19 test at most 3 days prior to the event, (ii) wear a mask at all times while attending this event, and (iii) maintain proper social distancing protocols at the event.

Guests who voluntarily disclose that they are fully vaccinated may follow the guidance for fully vaccinated individuals, including masking and social distance protocols consistent with CDC guidance.

For purposes of this attestation, guests are considered “fully vaccinated” once two weeks have passed since their second dose of a two-dose COVID-19 vaccine (Pfizer or Moderna) or two weeks after receiving a single dose of a one-dose vaccine (Johnson & Johnson/Janssen).

Please indicate your response below. If you indicate that you have not been fully vaccinated or you decline to answer whether you have been vaccinated, then proof of a negative COVID-19 test taken within 72 hours of the event will need to be provided to your event POC as soon as possible.

UConn and UConn Foundation Employees Only 

Arrangements have been made through HR and UConn Health to test all impacted employees 24 hours in advance, as opposed to the 72 hour description below. Plan to be available on Thursday, October 14 for testing. Testing will occur at the Brown building. Time for testing will be sent separately.

By submission of this form, I, as a UConn employee, authorize UConn Health and/or Employer/School/Venue’s authorized agents (each a “Test Administrator”) to test me for COVID-19 for this event. ​​​​​​I authorize Test Administrators to provide any and all of my COVID-19 test results (Test Results) to me as the person tested, to the UConn Health COVID-19 Call Center, and state health authorities as may be required. I further authorize Test Administrators to provide my Test Results to appropriate University of Connecticut personnel with a legitimate interest in the results.