AWS - Scheduled COVID Testing

Scheduled COVID Testing
Instructions: Aurora Waldorf School is required to report to the New York State Department of Health by Friday each week. Please fill out this form after scheduling a COVID test. Please DO NOT wait until the test is done to complete the form.
Name*

First NameLast Name
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
County of Residence*
Date of Birth*

MonthDayYear
Date
Gender*

MaleFemaleTransgender/Gender non-conforming
Race*

American Indian or Alaska NativeAsianBlackPacific IslanderMultiracialWhiteNo ResponseOther
Role of the person getting tested*

StudentFacultyStaff
Lab Result
to be filled in by AWS after receiving a copy of test results
Lab Performing Test*
Ordering Physician
Test Date*

MonthDayYear
Date
Submitter's Email*
example@example.com
Should be Empty: