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Hastings-on-Hudson COVID Rapid Test Registration Form
Once you have made your COVID test appointment, please complete ONE form for EACH child being tested.
Thank you for your cooperation.
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* Indicates required question
Email
*
Your email
Last Name of Child Being Tested
*
Your answer
First Name of Child Being Tested
*
Your answer
Date of Birth of Child Being Tested
*
MM
/
DD
/
YYYY
Street Address of Child Being Tested
*
Your answer
City of Child Being Tested
*
Your answer
State of Child Being Tested
*
Your answer
Zip Code of Child Being Tested
*
Your answer
Best Contact Phone Number
*
Your answer
Name of the School the Child Being Tested Attends
*
Hillside Elementary
Farragut Middle School
Hastings High School
Date of Test Appointment
*
MM
/
DD
/
YYYY
A copy of your responses will be emailed to the address you provided.
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