VRS Covid-19 Minors Registration

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Parent/Guardian Search Parameters

Registration Type: *

Birth Registration Number (BRN): *

Citizen Certificate Number (CCN): *

Permit Number: *

Date of Birth: *

Are You Parent/Guardian of the Child:

Parent Guardian

Clear

Birth Certificate Information

Birth Registration Number:

Given Name(s):

Surname:

Date of Birth:

Age:

Gender:

Place of Birth:

Father's Name:

Mother's Name:

Citizen Certificate Information

Citizen Certificate Number:

Given Name(s):

Surname:

Date of Birth:

Age:

Gender:

Country of Birth:

Permit Certificate Information

Permit Number:

Given Name(s):

Surname:

Date of Birth:

Age:

Gender:

Country of Birth:

Parent/Guardian Contact Information

Primary Mobile Phone Contact: *

Please enter your 7 digit Primary Phone Contact e.g 9999999

Primary Email Address:

Please enter your Primary Email Address e.g user@gmail.com

Secondary Mobile Phone Contact:

Please enter your 7 digit Secondary Mobile Phone Contact e.g 9999999

Secondary Email Address:

Please enter your Secondary Email Address e.g user@gmail.com

All SMS and Email Notifications will be delivered to the primary contacts only.

Child Search Parameters

RecordType *

Birth Registration Number (BRN): *

Citizen Certificate Number (CCN): *

Permit Number: *

Date of Birth: *

Clear

Birth Certificate Information

Birth Registration Number:

Given Name(s):

Surname:

Date of Birth:

Age:

Gender:

Place of Birth:

Father's Name:

Mother's Name:

Citizen Certificate Information

Citizen Certificate Number:

Given Name(s):

Surname:

Date of Birth:

Age:

Gender:

Country of Birth:

Permit Certificate Information

Permit Number:

Given Name(s):

Surname:

Date of Birth:

Age:

Gender:

Country of Birth:

Child Address Information

Nearest Health Facility: *

Please choose the Nearest Health Facility

Flat Number/ House Number/ Street Name:

Please enter the Flat Number/ House Number/ Street Name e.g Lot 2 Cyber Road

Settlement/Area/Koro: *

Please enter the Settlement / Area / Koro e.g Laucala Beach

City/Town:

Sub-Division:

Division:

Island:

Education Information

Which form of education is your child undergoing? *

Please choose the form of education the child undergoing

School that the Child is Attending: *

Please choose the School the child is attending

Parent/Guardian Identity Details

Select ID Card Type: *

Please choose the ID Card Type e.g Voter ID

ID Card Number:

Please enter your ID Card Number e.g. S11111111

Valid ID Card: *

Please upload an e-copy of the ID Card chosen above (Voter ID Card / Driver Licence / FNPF & TIN Joint Card / Passport / Student ID)

I, hereby declare that I am a parent/guardian of the child and consent for the child to be vaccinated.

I, hereby confirm that the information provided herein are accurate and complete.

I, hereby declare that I am a parent/guardian of the child and consent for the child to be to part of the Win Together Sweepstakes draw.

The Fijian Government

COVID-19: VACCINATION REGISTRATION FORM

Parent/Guardian Search Parameters

Birth Certificate Information

Citizen Certificate Information

Permit Certificate Information

Parent/Guardian Contact Information

Child Search Parameters

Birth Certificate Information

Citizen Certificate Information

Permit Certificate Information

Child Address Information

Child's Medical Information

Parent/Guardian Identity Details