COVID Testing Adult and Student Consent Form

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COVID Testing Adult and Student Consent Form

Informed Consent for Health Care and COVID-19 Vaccinations for Students Experiencing Homelessness, Students over 18 and Students whose parents can sign.

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* Indicates required question

Email *

Your email

First Name *

Your answer

Last Name *

Your answer

Date of Birth *

MM

/

DD

/

YYYY

What is your Cell/Mobile #? *

Your answer

Have you been diagnosed with COVID-19 in the past 90 days? *

Yes

No

Are 18 years of age or older? *

Yes

No

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