CBI Vaccination Record Upload

Please fill out your name and e-mail address, point to an image file for your vaccination record and submit this form.
Your vaccination record must show that you are fully vaccinated (2 shots of Moderna/Pfizer or one shot of J&J) plus a booster. If you have a special situation, please contact our office.
Once the office has reviewed your vaccination record, they will send you a confirmation that you have been added to our pre-approved list and you will not be required to show proof of vaccination at the door. The list of pre-approved individuals will be maintained in our office and made available to our office staff and volunteer ushers.

Last Name:
First Name:
Vaccine Card Image File: