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Covid-19 Self-Test Form
Please fill out the form below after receiving the results from your self-test kit.
The information collected is for Administration only.
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* Required
Date
*
MM
/
DD
/
YYYY
NAME (Last name, First name)
*
Your answer
Self-test results?
*
Positive
Negative
Void
Required
Your role at B.I.?
*
Choose
Student
Faculty/Teacher
Staff
Pastor
Board Member
Grade Level ?
*
Choose
None
Pre-K
K
1
2
3
4
5
6
7
8
9
10
11
12
All Grades
Only High School
Only Elementary
Only Middle School
Middle and High School
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