Sign Up for Weekly Voluntary COVID Surveillance Testing

Child 1

COVID Screening Testing Policy for Students

Per NY State Department of Health requirements, when the school is in low or moderate risk of transmission per CDC metrics we will provide weekly COVID screening, onsite and free of charge, to all families who desire it.

This testing is voluntary and you must use this form to opt in to it. You only need to complete it once, and we will use the information you provide to test your child weekly. This form needs to be completed by Friday, January 28, 2022

If you wish to opt-in or opt-out after this date, kindly send an email requesting this to reidm@albanyacademies.org and your child will added to or removed from the weekly testing list.

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* 1. Please provide your contact information

Parent First Name

Parent Last Name

Parent Email to send results notification

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* 2. I would like to have my child participate in weekly surveillance testing for COVID. (Please provide information for each child including first name, last name, date of birth, grade and campus.)

Child 1 First Name

Child 1 Last Name

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* 3. What is the child's date of birth?

Child 1 Date of Birth

Date

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* 4. Grade Level

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* 5. On which campus is this child enrolled?

AAG

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* 6. I have created a profile for this child at https://app.clarifi-covid-19.com/

Yes

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* 7. I would like to sign up another child

Yes

No, I am ready to submit the survey