Green Island UFSD COVID-19 Attestation Form

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STUDENT ATTESTATION OF RAPID ANTIGEN COVID-19 HOME TEST RESULT TO RETURN TO SCHOOL

Email *

Student First & Last Name *

Student Grade *

Student Date of Birth *

YYYY

Vaccination Status *

Fully Vaccinated

Unvaccinated

Not Fully Vaccinated

Test Date *

YYYY

Test Time (AM/PM) *

Time

Test Result *

Positive

Negative

I, (parent/guardian - insert name below), do hereby affirm that my child has tested with the above above negative results and symptoms are resolved, OR the above positive results and has isolated for 5 days after symptoms began/+ test results obtained and is therefore permissible to return to school.

*

A copy of your responses will be emailed to the address you provided.

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