Test-to-Stay/Play Affirmation
Please use this form to report results from an at-home COVID test for participation in our Test-to-Stay/Play programs. Details on the program, as well as a way to request additional tests, can be found in the following document : https://www.frewsburgcsd.org/cms/lib/NY02214391/Centricity/Domain/2273/Test%20to%20Stay%20and%20Play%20Letter.pdf

If you have any questions, please call the school at 716-569-7069.

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Email *
Student's Name *
Student's Date of Birth *
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Parent/Guardian's Name *
Date of Test *
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DD
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YYYY
Results of Test *
By electronically signing below, I attest that:
I have administered an at-home COVID test to my above-named child, on the date indicated above, and the results of the test were as indicated above.
Acknowledgment of Electronic Signature *
Required
Parent/Guardian Signature (or student sIgnature if legally able to sign) *
Please type your full name.
Today's Date *
MM
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DD
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YYYY
A copy of your responses will be emailed to the address you provided.
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