SHIELD COVID-19 Testing Opt-In/Opt-Out Form
SHIELD Testing will continue for the remainder of the school year. If you wish to have your student(s) to continue to participate, or opt-in to participate for the remainder of the school year, please complete this form by TUESDAY, JAN. 10. Test kits will only be sent to those who complete this form.
Each month, a supply of testing materials will be sent home with your student. Saliva test samples must be returned to school and dropped in a designated container in the building on Tuesday each week. You will be notified if your student has a positive result.

Please complete this form to indicate you wish your child to do weekly (unobserved by any school personnel) at-home testing. An individual form must be completed for each child.
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Student Last Name *
Student First Name *
Student Date of Birth *
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DD
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YYYY
Student's School/Program *
By selecting the option below, I attest that: I have submitted this form freely and voluntarily, and I am legally authorized to make decisions for the child named above. *
Parent/Guardian Full Name *
Parent/Guardian Mobile Number *
Parent/Guardian email address *
Best way to contact you: *
Student Home address *
Student ID number (if you know it)
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