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.
Sign in to Google to save your progress. Learn more
Student First and Last Name *
School *
Grade *
Date of Birth *
MM
/
DD
/
YYYY
Please indicate your child's gender *
Home Address *
Parent Phone Number (555-555-5555) *
Parent Name *
I acknowledge and provide consent as outlined above. *
Required
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Clarence Central School District. Report Abuse