Movement Research collects COVID-19 Vaccine Verification Form for internal use only. As of September 13th, 2021, all individuals visiting a Movement Research location must:

  • Be fully vaccinated (i.e., two weeks following receiving both doses of a two-dose vaccine or a single dose of a one-dose vaccine) with a COVID-19 vaccine authorized for emergency use by the FDA or WHO , and
  • Must provide proof of vaccination at least 48 hours in advance by completing this form. As stated in the Key to NYC guidelines, proof of vaccination includes: CDC vaccination card (A photo or photocopy of this card is also acceptable); NYC Vaccination Record (A photo or photocopy of this card is also acceptable); NYC COVID Safe App; Excelsior Pass
  • Individuals must also provide a form of photo identification, which may include driver’s license, passport, government issued ID, school issued ID, or work issued ID card.

In addition:

  • Anyone accessing the 122 Community Center building Monday to Sunday between 12pm-5pm, needs to complete this form and display their proof of vaccination and photo ID as they enter the building.
  • As MR programs are specifically designed to serve adult populations, unvaccinated children are not permitted on-site at this time, unless an exception is cleared with MR Staff in advance.
  • As per Key to NYC guidelines, any individual who submits falsified vaccination records will not be permitted to enter the facility.

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