Hebrew Academy OC Covid-19 Testing Online Registration Form (Faculty)

If you have any questions please call us at 866-215-7781

BEFORE YOU START, IF YOU ARE EXPERIENCING ANY OF THESE SYMPTOMS, STOP AND CALL 911:
- Constant chest pain or pressure
- Extreme difficulty breathing
- Severe, constant dizziness or light-headedness
- Slurred speech
- Difficulty waking up

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* 1. First name:

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* 2. Last name:

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* 3. What is your gender?

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* 4. Date of birth (MM/DD/YYYY):

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* 5. Email address:

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* 6. What is the address where you currently live?

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* 7. Cell Phone Number - To Receive Important Updates

 
 12% of survey complete.

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