Student Opt-In Form for Participation in the At Home Antigen Testing Program

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Both vaccinated and unvaccinated individuals are strongly encouraged to opt-in.

Parent/Guardian Last Name *

Parent/Guardian First Name *

Parent/Guardian Email address *

Student's Last Name *

Student's First Name *

Student's Grade Level *

Other

Student's School Name *

AES

CES

AMS

AIHS

AHS

Opt-In *

Yes, I opt-in my student to participate in the at-home antigen test program (please read and sign the form below)

No, I do not opt-in my student to participate in the at-home antigen test program (no further action needed)

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 Tuesday AFTER SCHOOL.

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 my child's school nurse.

Required

I understand that by submitting this form, I am agreeing that I have been informed about the at-home testing 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 questions at any time. I voluntarily opt-in to this program for my student. My submission of this form is the equivalent of my signature. Parent name: *

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