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Opt-In Form for Staff Participating in the At-Home Antigen Test Program
Both vaccinated and unvaccinated individuals are strongly encouraged to opt-in
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* Indicates required question
Email
*
Your email
Staff Members Name
*
Your answer
Staff Members School Name
*
If you are a district employee, select the school where you want your tests delivered.
Choose
Berkley Middle School
Berkley Community School
Staff Member Role
*
Choose
School Staff Member
Surround Care Staff Member
Cafeteria Staff Member
Opt-In
*
Yes, I opt to participate in the at-home antigen test program (please read and sign form below).
No, I do not opt to participate in the at-home antigen test program (no further action needed).
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