Dar-us-Salaam
Covid-19 Test - STUDENTS
NOTE: If you tested at Al Huda School, you do not need to submit this form. We have received a copy of your results.
NO RAPID or AT-HOME Tests
Student Name
*
First
Last
Grade
*
KG - Girls
KG - Boys
1st - Girls
1st - Boys
2nd - Girls
2nd - Boys
3rd - Girls
3rd - Boys
4th - Girls
4th - Boys
5th - Girls
5th - Boys
6th - Girls
6th - Boys
7th - Girls
7th - Boys
8th - Girls
8th - Boys
9th - Girls
9th - Boys
10th - Girls
10th - Boys
11th - Girls
11th - Boys
12th - Girls
12th - Boys
Hifzh - Girls
Hifzh - Boys
Date of Birth
*
MM
/
DD
/
YYYY
date of birth must be correct
Date of Test
*
MM
/
DD
/
YYYY
What was the result of the Covid test?
*
NEGATIVE
POSITIVE
Did the student have symptoms?
*
Yes
No
Symptoms
*
Have the symptoms improved?
*
Yes
No
Upload Test Result (scan/photo/PDF)
*
Parent Email Address
*
Do Not Fill This Out
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