COVID Test Consent Form

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COVID Test Consent Form

Please fill out this form for each scholar who attends Genesis

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* Indicates required question

Scholar Last Name *

Your answer

Scholar First Name *

Your answer

Scholar Date of Birth *

MM

/

DD

/

YYYY

I give my consent for my scholar (named above) to be tested for COVID-19 at Genesis. *

Yes

No

Scholar's Academy *

Girls Academy

Boys Academy

Scholar Grade *

Choose

Grade K

Grade 1

Grade 2

Grade 3

Grade 4

Grade 5

Grade 6

Grade 7

Grade 8

Grade 9

Grade 10

Parent Last Name *

Your answer

Parent First Name *

Your answer

I attest that I am a legal parent/guardian of the scholar listed above *

Yes

No

Submit

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