Attestation of At-Home COVID-19 Test Result
I attest that the at-home / over-the-counter rapid COVID-19 test described below was performed on the following student.  The test was administered on the individual and the results belong to the test performed on them.  The test was performed following the instructions provided by the test kit.  

Students must receive District-issued quarantine guidance through the school BEFORE they submit verification of at-home rapid-test results. At-home rapid-test results will not be accepted for individuals exhibiting symptoms.  Symptomatic individuals must follow isolation guidelines as stated in the most recent DHEC exclusion guidance.  Schools will not be able to accept at-home rapid-test results if student guidance has not been previously issued.


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Legal name of student who was tested: *
Student's Date of Birth: *
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School: *
Grade: *
Homeroom Teacher (if applicable or N/A): *
Date Tested: *
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Time Tested: *
Time
:
Brand of Home Test: *
Serial Number on Test Packaging: *
Test Result as Observed by the Parent or Designated Adult Who Performed the Test: *
Electronic Signature of Individual Performing the At-Home COVID-19 Test Referenced in This Form.  I attest that my name affixed hereto is an electronic signature affixed to this form and is the legal equivalent of my manual signature on this agreement. *
Electronic Signature of Parent or Legal Guardian of Individual Performing the At-Home COVID-19 Test Referenced in This Form (if different from above).  I attest that my name affixed hereto is an electronic signature affixed to this form and is the legal equivalent of my manual signature on this agreement.  
Date of Electronic Signature(s): *
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