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Jefferson COVID Testing Results
Please complete this form after your child has taken a COVID test. If you child tested positive, the nurse will call you to discuss the next steps as soon as possible.
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* Indicates required question
Please enter YOUR email address:
*
Your answer
Enter the best phone number at which to reach you:
*
Your answer
What is your student's LAST name:
*
Your answer
What is your student's FIRST name:
*
Your answer
Please enter your FIRST & Last Name:
*
Your answer
What type of test did this student take?
*
Home rapid test
Rapid test at BUSD site
Rapid (Antigen) test at a Clinic/Medical Facility
PCR test at a Clinic/Medical Facility
Other:
On what date was the test taken?
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MM
/
DD
/
YYYY
Were the results positive or negative?
*
Positive
Negative
My student attends a childcare program AT JEFFERSON.
*
Yes
No
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