St. Madeleine Sophie’s Center is preparing to resume in person services based on our reopening plan, including home visits and on campus programming tentatively scheduled to begin on March 1, 2021. At this time, in order to receive in person services, we are requiring that program participants have at least begun the COVID-19 vaccination process. Please complete the following survey with regard to the vaccine by February 16, 2021. Depending on your responses we may contact you for further information. Thank you, and we look forward to getting back to some normalcy as soon as possible.

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* 1. Program Participant Name:

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* 2. Program:

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* 3. Where does the SMSC program participant live?

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* 4. Has the program participant received the vaccine?

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