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Students - Reporting an LFD home test result
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What is your child's first name?
*
Your answer
What is your child's surname?
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Your answer
Date of test
*
MM
/
DD
/
YYYY
Test result
*
Negative
Positive
Void
Reference / Log number on the test
*
Your answer
Name of person completing this form
*
Your answer
Relationship to child
*
Your answer
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