Wilmot SHIELD Testing - I do not want my child to test this week

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By filling out this form, you are acknowledging that you do not want your child to participate in SHIELD testing this week. Their consent form for SHIELD testing will remain on file, so they will have the opportunity to be tested in future weeks or if needed for the Test To Stay protocol. Please note that if you wish to do this for multiple weeks, you will need to fill out this form each week.

If you want your consent revoked completely, please email Kristin Neu (kneu@dps109.org). Please note that if you decide to go this route, and then later want to reinstate consent, you will need to fill out a new form, and it may take 2 weeks or longer for SHIELD Illinois to roster your child back into the system.

Please fill out one form per child.
Please do not reach out to your child's teacher about SHIELD testing.
If you have any questions, please contact Dr. Brett (ebrett@dps109.org)

Email *

Child's last name: *

Child's first name: *

Grade my child is in: *

My child's homeroom teacher: *

I acknowledge that I am opting my child out of the upcoming testing cycle, but am not revoking consent for testing. My child's name will appear on the testing roster again next week, and if I don't want them to participate, I will have to fill this form out again next week. *

I acknowledge the above statement.

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