SHC Student COVID-19 Testing Sign-Up
At this point, only SHC Boys Volleyball Players should be on this Google Form.
If you have completed this Google Form before, there is no need to do it again (we actually prefer that you don't) unless your health insurance or some other piece of information has changed.
This form must be completed in its entirety (either from previously or now) in order for an SHC student to take a COVID-19 Test from PMH Laboratories at SHC. This is information required by PMH Laboratories.
Sign in to Google to save your progress. Learn more
Email *
Student's First Name *
Student's Last Name *
Student's Gender *
Student's Date of Birth *
MM
/
DD
/
YYYY
Home Address *
Home City *
Home State *
Home Zip Code *
Phone Number *
Parent/Guardian E-Mail Address for Results - this is the e-mail address test results will be sent to *
Health Insurance CARRIER - type none if not insured *
Health Insurance GROUP NUMBER - type none if not insured *
Health Insurance MEMBER NUMBER - type none if not insured *
Student's Grade in School *
Name of Person/Parent completing this form *
E-mail of Person/Parent completing this form *
Cell Phone Number of Person/Parent completing this form *
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of Sacred Heart Cathedral Preparatory. Report Abuse