By completing and submitting this form, I attest that:

• I have signed this form freely and voluntarily, and I am legally authorized to make decisions for the student.

• I understand and agree that nothing herein shall relieve the parent, guardian, legal guardian, foster care provider, or student named from any liability associated with the student not obtaining a COVID-19 test.

• I further acknowledge that by opting my child out of COVID-19 testing, that my child will be required to follow the quarantine guidelines of the West Allis-West Milwaukee School District et al. and the West Allis Health Department if determined to be a close contact.

• I knowingly and freely assume all such risks arising from opting my child out of COVID-19 testing.

• I agree on behalf of myself, my spouse, and the student to hereby release, exonerate, discharge and hold harmless the West Allis-West Milwaukee School District et al., its officials, agents, and/or employees, (collectively “the District”) from any and all liability, claims, causes of action or demands, including attorney’s fees, fines, or other costs (e.g. medical costs), with respect to any and all illness, disability, death, or loss or damage to person or property associated with the student opting out of COVID-19 testing.

• I understand that the student is subject to any guidance or requirements issued by the District related to school bus operations for field trips.

• I understand that the student may be subject to additional mitigation measures including but not limited to use of face coverings, symptom screening, and physical distancing.

• I understand that if I am a student age 18 or older, or a student who may otherwise legally consent, references to “the student” refer to me and I may sign this form on my own behalf.

• I will notify the student’s school in writing if I choose to revoke my consent and permit COVID-19 testing.