WCPS Test-to Stay Testing Program
I have read the Virginia Department of Health Test to Stay Information Sheet and give my consent for the student listed below to participate in this program.  I understand the risks and benefits of this program, and understand that I may withdraw my consent at any time.  I agree to abide by the requirements of this program (e.g. daily testing, consistent mask use while on school property and while riding the school bus, and accurate reporting of at-home COVID-19 test results) and understand that if the requirements are not followed, the student will be removed from the program and will be required to quarantine at home following close contact with an individual who has tested positive for COVID-19.
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Student's Last Name *
Student's First Name *
Student's Middle Name
Student's Date Of Birth *
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Student's Gender *
Student's Race *
Required
Is the Student Hispanic/Latino *
Student's School *
Student's Homeroom Teacher *
Student's Grade Level *
Parent/Guardian Last Name *
Parent/Guardian First Name *
Parent/Guardian Middle Name
Parent/Guardian Date of Birth *
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YYYY
Parent/Guardian Street Address *
Parent/Guardian City *
Parent/Guardian Phone
Parent/Guardian Alternate Phone
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