Alternative to Quarantine Pilot - Parent/Family Agreement for Harriet Bishop Elementary
By completing "yes" to this form, you are agreeing to opt in to the the Alternative to Quarantine pilot program at your school. Any individual answering "no" to this form or anyone not responding to the form will not be included in the pilot program. The pilot program begins on October 25 and will continue through mid-December.

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Email *
Your first name *
Your last name *
Your phone number *
Your email address *
You will complete this section for each child that will participate in this program at Harriet Bishop Elementary.
Child's first name *
Child's last name *
Student ID Number *
Child's Grade Level *
Child's Teacher *
I consent to participate in the pilot program and I acknowledge and agree that when my child is participating in at home daily testing as an option to quarantine, that I provide the results of this child's daily test through our HIPPA compliant format. Additionally, I acknowledge that exclusion criteria may prohibit my child from participating in the alternate quarantine program. *
I have access to a device (smart phone, computer, tablet) to take and upload a photo of the test results. *
Please complete the following information for additional children that will participate in this program at Harriet Bishop Elementary. If this does not pertain to you, please scroll to the bottom of the form and hit "submit".
Child's first name
Child's last name
Student ID Number
Child's Grade Level
Clear selection
Child's Teacher
I consent to participate in the pilot program and I acknowledge and agree that when my child is participating in at home daily testing as an option to quarantine, that I provide the results of this child's daily test through our HIPPA compliant format. Additionally, I acknowledge that exclusion criteria may prohibit my child from participating in the alternate quarantine program.
Clear selection
I have access to a device (smart phone, computer, tablet) to take and upload a photo of the test results.
Clear selection
Child's first name
Child's last name
Student ID Number
Child's Grade Level
Clear selection
Child's Teacher
I consent to participate in the pilot program and I acknowledge and agree that when my child is participating in at home daily testing as an option to quarantine, that I provide the results of this child's daily test through our HIPPA compliant format. Additionally, I acknowledge that exclusion criteria may prohibit my child from participating in the alternate quarantine program.
Clear selection
I have access to a device (smart phone, computer, tablet) to take and upload a photo of the test results.
Clear selection
Child's first name
Child's last name
Student ID Number
Child's Grade Level
Clear selection
Child's Teacher
I consent to participate in the pilot program and I acknowledge and agree that when my child is participating in at home daily testing as an option to quarantine, that I provide the results of this child's daily test through our HIPPA compliant format. Additionally, I acknowledge that exclusion criteria may prohibit my child from participating in the alternate quarantine program.
Clear selection
I have access to a device (smart phone, computer, tablet) to take and upload a photo of the test results.
Clear selection
Submit
Clear form
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