Request for COVID-19 Testing Kits
Governor Hochul and State Health Commissioner Bassett have identified a statewide goal of having as many students as possible tested for COVID as they return to school following our winter break. To accomplish this, the state has provided enough rapid testing kits to give to every Frewsburg student.  These test kits are intended for families to use to test their child(ren) after winter break regardless of if your child has symptoms or not.  

Please note that the expiration date on the tests may say January 2022.  These tests are good until the end of April 2022.  

If your child tests positive after using the COVID kit, please have your child stay at home and contact COVID Nurse Jessica Carraher at (716) 569-7039.  If your child tests negative, do nothing.

Please complete one form for each child.  
 
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Email *
Student's Name *
Student's Grade *
Building *
Student's Teacher (MS/HS- please list 9th period teacher) *
I would like the COVID test kit to be... *
By electronically signing below, I attest that:
- I have signed this form freely and voluntarily, and I am legally authorized to make decisions for the child named above;
- I authorize the Frewsburg Central School District to provide a COVID test kit for my child.
- I authorize my child’s test results and other information to be disclosed to any governmental entity as may be required or permitted by law.
- I acknowledge that a positive test result will require my child to be sent home from school and remain at home until he/she/they meet(s) the criteria to return to school according to the Chautauqua County Health Department.
- I understand that this testing does not replace treatment by my child’s medical provider, and I assume complete and full responsibility to take appropriate action regarding my child’s medical treatment in light of the test results.
- I understand that, as with any medical test, there is the potential for a false positive or false negative COVID-19 test result.
- I understand that if I am a student eighteen (18) years of age or older, or may otherwise legally consent for my own health care, references to “my child” refer to me, and I may sign this form on my own behalf.
Acknowledgment of Electronic Signature *
Required
Parent/Guardian Signature (or student sIgnature if able to give self-consent) *
Please type your full name.
Parent/Guardian Phone Number *
Today's Date *
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A copy of your responses will be emailed to the address you provided.
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