Alternative to Quarantine Pilot - Parent/Family Agreement - Willow Creek Middle School
By completing "yes" to this form, you are agreeing to opt in to the the Alternative to Quarantine pilot program at your school. Any individual answering "no" to this form or anyone not responding to the form will not be included in the pilot program. The pilot program begins on November 8 and will continue for up-to at least six weeks.
Sign in to Google to save your progress. Learn more
You will complete this form for each child that will participate in this program at Willow Creek Middle School.
Student ID Number *
Child's first name *
Child's last name *
Child's Grade Level *
Parent/Guardian's first name *
Parent/Guardian's last name *
Parent/Guardian's email address *
Parent/Guardian's phone number *
I consent to participate in the pilot program and I acknowledge and agree that when my child is participating in at home daily testing as an option to quarantine, that I provide the results of this child's daily test through our HIPPA compliant format. Additionally, I acknowledge that exclusion criteria may prohibit my child from participating in the alternate quarantine program. *
I have access to a device (smart phone, computer, tablet) to take and upload a photo of the test results. *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Rochester Public Schools ISD 535. Report Abuse
Google Forms