Covid Testing Kit Order Form

Covid testing kits from California Department of Social Services (CDSS) have arrived. We are doing our best to distribute the Covid Testing Kits to those in need. Below are the distribution amounts based on the number of kits received in Contra Costa. You will receive your kits either by mail, delivery or arrangements made in advance for pick up at the CocoKids area offices. Please indicate in the comment section below if you have a preference.

Centers – 90 single tests
Large FCC – 24 single tests
Small FCC – 12 single tests
Exempt Providers – 4 single tests

If you would like to receive your allotted amounts, please complete the form below with the information required by CDSS.
We thank you for your dedication to the children and families in your care.

Monica Joseph
Quality Improvement Manager
925-265-6467

Covid Testing Kit Order Form

Facility Type :
Select the facility type in the drop box above
Program Name
Enter the program's name in the text box above
License Number :
Enter the program's license number in the text box above
Contact Person :
First Last
Address
Street Address City ZIP / Postal Code
Email

Enter the contact person's email in the text box above
Phone
Enter the contact person's phone number in the text box above
Facility Capacity:
Enter the facility's capacity in the text box above
Number of Children in Care:
Enter the number of children in care in the text box above
Number of Staff:
Enter the number of staff in the text box above
Tax Status :
Select the facility's tax status in the drop box above
Comments
Add any comments in the text box above.