Editing previous response:

Please fix the highlighted areas below before submitting.

COVID CONSENT FORM

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Parent/ Guardian Contact Information

Parent/Guardian Name*

Answer required for "Parent/Guardian Name"

Parent/Guardian Mobile Phone*

Number Required

Parent/Guardian

Answer required for "Parent/Guardian"

Student Name *

Answer required for "Student Name "

Student Date of Birth *

Answer required for "Student Date of Birth "

Student OSIS #

Answer required for "Student OSIS #"

Student School *

Answer required for "Student School "

Virtual Signature: I give my child permission to get tested weekly at P.S. 106K*

Answer required for "Virtual Signature: I give my child permission to get tested weekly at P.S. 106K"