Attestation of At-Home Rapid Covid-19 Test Results

If your child has had a positive Home Rapid Covid-19 test, please fill out this form so the student's attendance can be updated.




Email *
I attest that the at-home/over-the-counter rapid COVID-19 test described below was performed on (First and Last  Name) ____________________________________. The test was administered on the individual and the results  belong to the test performed on them. The test was performed following the instructions provided by the test kit.  *
Student's Date of Birth:
 *
MM
/
DD
/
YYYY
School *
Date of Positive Test *
MM
/
DD
/
YYYY
Brand of Home Test: *
Serial Number on Test Packaging *
Test Performed By: *
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