Keefe Tech Opt-In Form for One-Time Distribution of COVID Test Kits for Home
Would you like free rapid antigen covid test kit for home for your student? If so, please fill out the form below. Students will be notified of where/when to pick up their test kits the Tuesday before Thanksgiving break. 

By completing and submitting this form, I confirm that I am the appropriate parent/guardian op opt my student into the One-Time at-home COVID-19 test distribution. Students aged 18+ can opt themselves into the program.

Opt-in: I understand that the school will only provide antigen test kits to those students who opt-in. 

Test Distribution: I understand that at-home tests will be given to my student to take home to use for optional return testing following Thanksgiving and December break. I understand that each test kit contains 2 tests and I will administer the tests to my student at my discretion. 

Reporting Test Results: I will report any positive test results to the Keefe Tech Nurses as soon as possible. 

Voluntary Participation: I understand that opting into this One-Time test distribution is completely optional and that I can choose not to participate at any time. I should contact the Keefe Tech Nurses at any time with any questions or concerns. 
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Email *
Student LAST Name *
Student FIRST Name *
Student Date of Birth *
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/
DD
/
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Student Grade *
Parent Name *
Parent email  *
YES, I opt-in my student to participate in the One Time at-home COVID test kit distribution program *
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