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Covid Home Test Kit Request
* Required
Name of parent or guardian
*
Your answer
School your student attends.
*
Nokomis Regional High
Nokomis Middle School
Etna-Dixmont Elementary
Sebasticook Valley Elementary
Somerset Valley Elementary
Students first and last name:
*
Your answer
I would like to . . .
*
send a test kit home with my student.
come into the school to pick it up.
Phone number the school nurse can reach you:
*
207 123-4567
Your answer
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This form was created inside of Regional School Unit #19.
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