Request for At-Home COVID Kit Pick-up 1/6

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Request for At-Home COVID Kit Pick-up 1/6

Solicitud de kit de prueba COVID en casa

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* Indicates required question

Last Name of Parent (Apellido del padre): *

Your answer

First Name of Parent (Nombre del padre) *

Your answer

School(s) children attend (escuelas a las que asisten los niños):

Your answer

Pick-up appointment time at the Middle School (select one) (Hora de la cita de recogida (marca uno) :

Choose

4:00 p.m.

4:30 p.m.

5.00 p.m.

5:30 p.m.

Submit

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