Agawam Public Schools
STUDENT OPT-IN  FORM - JANUARY 2022

Please fill out this Opt-in form for students participating in the at-home antigen test program.
Both vaccinated and unvaccinated individuals are strongly encouraged to opt-in.


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Email *
Parent/Guardian Name: *
Parent/Guardian Email address *
Students  First Name: *
Students Last Name *
Students Grade Level *
Students School Name *
Opt - In *
Required
Opt-In Stipulations - By completing and submitting this form, I confirm that I am the appropriate parent, guardian, or legally authorized individual to opt into the at-home antigen testing program:                               Opt-in: I understand that Agawam Public Schools will provide the at-home antigen tests to only those students, vaccinated or unvaccinated, who opt-in. Training: I understand that Agawam Public Schools will provide the prerequisite at-home antigen test administration training materials, including instructions on when tests should be taken, to me. I agree to take this training prior to administering the test on my child.              Test distribution: I understand that at-home tests will be given to my student to take home every two weeks. I understand that each test kit contains two individual tests, and I will administer the test on my student on each Wednesday before school.                         Reporting test results: I understand that if my student tests positive, I will report the positive test result to my student’s school and my healthcare professional. I understand the school will keep any reported test results confidential and individual results will not be made public.                                                                Voluntary participation: I understand that opting into the at-home antigen test program is optional and that I can choose not to participate at any time. To cancel this opt-in for the at-home antigen testing program, I need to contact the main office of your child’s school. I, the undersigned, have been informed about the at-home antigen test program, procedures, and I have received a copy of this opt-in form. I have been given the opportunity to ask questions before I sign, and I have been told that I can ask additional questions at any time. I voluntarily opt-in to this program for my student:
A copy of your responses will be emailed to the address you provided.
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