LI 2022 COVID19 PCR Test Form
Participant Name
*
First Name
Last Name
Participant Email
*
example@example.com
Participant Cell Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Birth date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Guardian/Emergency Contact Names
*
First Name
Last Name
Guardian/Emergency Contact Email
*
example@example.com
Guardian/Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Guardian/Emergency Contact Relationship
*
Program that you will be either a LI Team Lead or Operations Staff at
*
In-Person YDP Programs (July 10th - July 16th, 2022)
In-Person YDP Programs (July 17th - July 23rd, 2022)
In-Person YDP Programs (July 24th - July 30th, 2022)
In-Person YDP Programs (July 31st- August 6th, 2022)
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Please upload proof of your negative COVID Test taken within the last 48 Hours.
*
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