Test-to-Stay (TTS) Consent Form
If your child has been exposed to an individual who has tested positive for COVID-19, he or she is eligible to participate in the "Test-to-Stay" (TTS) program. In order for your child to be allowed into the TTS program, please read the following carefully before completing the consent form below. You will need to complete a separate form for each one of your children.
I have read and understand the following: My child has not been fully vaccinated against COVID-19.
His/her COVID-19 exposure(s) occured at a community or school-related function. (Students whose COVID-19 exposures occurred at home are not eligible during the TTS program.)
Students with household COVID-19 exposures (e.g., siblings) are not eligible for the TTS program.
The COVID-19 infected student and the COVID-19 exposed student must have consistently and correctly worn well-fitting masks during the exposure.
The COVID-19 exposed student has not developed any signs or symptoms of COVID-19 at any time since their exposure.
The COVID-19 exposed student must correctly wear well-fitting masks in school at all times, other than when eating, drinking, or taking mask breaks.
Have an FDA-authorized COVID-19 rapid antigen test administered 2 times during the 5-day period following the exposure by an appropriately trained school employee or healthcare provider and receive a negative COVID-19 result prior to reporting to class. On days when school is not open (e.g. weekends, holidays), COVID-19 testing is not required.
At home COVID-19 tests do not qualify for this TTS program.
As a parent/guardian I agree to:
● Conduct active COVID-19 monitoring (explicitly asking the student about COVID-19 signs and symptoms each day before and after school).
● Immediately contact my child’s healthcare provider and ECDOH at 716-858-6525 if any COVID-19 symptoms develop.
● Promptly pick up my child from school, should they test COVID-19 positive or develop COVID-19 symptoms during school instruction.
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Student First and Last Name
Clarence Center Elementary School
Harris Hill Elementary School
Ledgeview Elementary School
Sheridan Hill Elementary School
Clarence Middle School
Clarence High School
Date of Birth
Please indicate your child's gender
Parent Phone Number (555-555-5555)
I acknowledge and provide consent as outlined above.
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This form was created inside of Clarence Central School District.