Lakeside JSD COVID-19 Testing Attestation Form
You are receiving this Attestation Form because your child has been absent with COVID-like symptoms. In order for your child to return to school, your child MUST: 1) be without fever for at least 24 hours (without fever-reducing medication), 2) show improving symptoms, AND 3) test negative for COVID-19. 

Please complete the below questions to attest to having administered a COVID-19 test to your child and to a negative test result.
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Child's name *
Child's grade *
What date was the rapid COVID-19 test administered on your child? *
MM
/
DD
/
YYYY
What was the test result? *
I certify the following to be accurate: 
The student named above was properly administered the COVID-19 antigen home test per package directions; I am stating the test result accurately; the test kit used is FDA approved or authorized by the FDA for emergency use (listed on the box).
 *
First and last name of the person certifying this test result *
My relationship to the above named student *
Email address *
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