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* 1. Your Name:

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* 2. Your Email Address:

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* 3. Child(ren) Name(s) 

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* 4. Please check the grade(s) your child(ren) is in.

***Please note, as of right now the state only will apply testing rules to children age 5 and above.

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* 5. Your School:

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* 6. If your school were to be designated as a Yellow Zone, would you give permission for your child to be part of the random COVID-19 testing initiative (20% of the school population every 2 weeks)?

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* 7. If your school were to be designated as an Orange or Red Zone, would you give permission for your child(ren) to be part of the mandatory COVID-19 testing initiative for reopening (please note, if you select "no", you would have to transition to fully remote learning until we were no longer in a designated zone).

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* 8. Would you consent to have your child tested for COVID-19, by a trained medical provider and with advanced notification, during the school day?

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* 9. Would you prefer to be present while your child is tested for COVID-19? 

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* 10. If testing student populations is mandated, would you prefer to receive COVID-19 testing from a medical provider at a Diocesan school over an urgent care provider?

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* 11. Optional: Comments

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