JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
RCSD - COVID Surveillance Testing Registration 2021-2022 (Students, Faculty & Staff)
Please complete ONE form for EACH individual being tested. Thank you!.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Last Name of Person Being Tested
*
Your answer
First Name of Person Being Tested
*
Your answer
Date of Birth of Person Being Tested
*
MM
/
DD
/
YYYY
Street Address of Person Being Tested
*
Your answer
City of Person Being Tested
*
Your answer
State of Person Being Tested
*
Your answer
Zip Code of Person Being Tested
*
Your answer
Best Contact Number
*
Your answer
School Person Being Tested Attends or Works at
*
Milton
Midland
Osborn
Rye Middle School
Rye High School
Central Administration Building
Please select one
*
Teacher (Includes All Instructional Faculty)
Staff (Includes administrators, pupil support services staff members, Clerical staff and any other non-instructional staff)
Student
Date of Testing Appointment
*
MM
/
DD
/
YYYY
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This form was created inside of Google Apps for Rye City School District.
Report Abuse
Forms
