MERSD At-Home Testing Program - Faculty & Staff
Opt-in Form for Faculty & Staff Participating in the DESE Sponsored At-Home Antigen Test Program
OK
*
1.
Last Name:
(Required.)
*
2.
First Name:
(Required.)
*
3.
The school building you are assigned to / work at the majority of the time.
(Required.)
Essex Elementary
Memorial School
Middle High School
4.
Have you had COVID within the past 90 days?
No
Yes
*
5.
Opt-in Form into the At-Home Antigen Test Program
(Required.)
Yes, I opt-in to the at-home antigen test program (
please read and sign electronically below
)
Current Progress,
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