STUDENT REWARDS CARD PROGRAM

Thank you for enabling your child to participate in weekly COVID-19 screening at your child’s school. We hope you are happy with the program and are receiving your child’s weekly COVID test results via text and/or email.

We have a new Student Rewards Card Program available to all students participating in weekly testing at their school.

• Student Rewards Card Amount: $15 per weekly test. Payments will be made on a prepaid Visa card.

• Student Rewards Cards are mailed directly to students once per month.

• Parental consent is required for their child to participate. In addition to the consent you have provided for testing, you will need to provide a consent for the Rewards Program.

• Parents can opt-in or opt-out for the Student Rewards Card Program at any time.

CONSENT FOR STUDENT REWARDS CARD PROGRAM BY PARENT/GUARDIAN.

(check “Yes” or “No” below with your name, child name and birthdate,

and your contact information)

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* 1. I understand that my child is eligible to participate in a Student Rewards Card Program which provides $15/weekly test. A Student Rewards Card will be mailed to the address provided when I registered my child for the weekly testing program. I understand that I can opt in or opt out of the Student Rewards Card Program for my child at any time. I understand that if I consent to my child participating in the Student Rewards Card Program, my child’s name and mailing address will be shared with the Student Rewards Card fulfillment vendor for the sole purpose of fulfilling and mailing the Student Rewards Card to my child. Student Rewards Cards are mailed 4-6 weeks after each month of testing throughout the school year.

Yes. I give my consent for my child to participate in the $15/weekly test Student Rewards Card Program as described above.

No, I do not want my child to participate in the Student Rewards Card Program at this time. I understand that I can opt-in to this program at any time for my child and can receive information from my school on how to do so.

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* 2. Child's School: Type Child's School

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* 3. Name of Parent/ Guardian: Type Your Name Here

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* 4. Name of Child: Type Child’s Name Here

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* 5. Child Birthdate: Enter Birthday Here

Date / Time

Date

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* 6. Parent Phone: Click Here to Enter Phone Number

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* 7. Parent Email: Click Here to Enter Email

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* 8. Signature: E-signature Here

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* 9. Date: Enter Date Here

Date / Time

Date