COVID Testing Form

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COVID Testing Form

Weekly In-School COVID Testing for Students at Aqsa School

Email *

1)I am a parent of a child at Aqsa School and I acknowledge that my student will be tested weekly in school for COVID19 during the 3rd Quarter of school. *

Yes

I will be requesting a different form

Required

Grade of Student *

2) I give my consent for the school to view results of my child's in-school COVID test *

Yes

I will email my results to the school

Required

3) Last Name of Student *

4) First Name of Student *

5) Birth Date of Student *

YYYY

6) Address: Number and Street *

7) City *

8) State *

9) Zip Code *

10) Gender of student *

11) Phone Number *

12) Email Address *

Submit

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