Vaccination Acknowledgement

The following waiver must be filled out by a Parent and/or Guardian for any teen prior to attending a BBYO chapter or regional overnight program. Teens will not be allowed to attend a BBYO overnight program without the submission of a waiver.

Name of Participant:

By signing below, I confirm that my teen is fully vaccinated against COVID-19 with one of the following vaccines: Pfizer, Moderna, Johnson and Johnson, AstraZeneca, or Novavax (fully vaccinated means two shots plus 2 weeks, or, one shot plus 2 weeks if your teen received the Johnson & Johnson vaccine). I understand I will have to present documentation if asked by BBYO. I also understand falsifying this statement will result my teen being removed from BBYO.

I further confirm that my teen is fully vaccinated with the following vaccines. I understand I will have to present documentation if asked by BBYO. I understand falsifying this statement will result my teen being removed from BBYO

  • Tdap (Diphtheria, Tetanus and Pertussis)
  • IPV (Poliovirus)
  • HIB (Haemophilus influenza type b bacteria)
  • PCV 13 (Pneumococcal) vaccine or PCV 23
  • MMR (Measles, Mumps, Rubella) or serologic evidence of immunity
  • Varicella vaccine (Chicken Pox), or serologic or historical evidence of immunity
  • Menactra (Meningococcal disease / Meningitis)