By completing and submitting this form, I confirm that I am the appropriate parent, guardian, or legally authorized individual to opt into the at-home antigen testing program:

•Opt-in: I understand that my school district will provide the at-home antigen tests to only those students and staff, vaccinated or unvaccinated, who opt-in.

•Training: I understand that my school district will provide the prerequisite at-home antigen test administration training materials, including instructions on when tests should be taken, to me. I agree to take this training prior to administering the test on my child.

•Test distribution: I understand that at-home tests will be given to my student to take home every two weeks. I understand that each test kit contains two individual tests, and I will administer the test on my student on each Sunday.

•Reporting test results: I understand that if my student tests positive, I will report the positive test result to my student’s school and my healthcare professional. I understand the school will keep any reported test results confidential and individual results will not be made public.

•Voluntary participation: I understand that opting into the at-home antigen test program is optional and that I can choose not to participate at any time. To cancel this opt-in for the at-home antigen testing program, I need to contact the School Nurse.

I, the undersigned, have been informed about the at-home antigen test program, procedures, and I have received a copy of this opt-in form. I have been given the opportunity to ask questions before I sign, and I have been told that I can ask additional questions at any time. I voluntarily opt-in to this program for my student: