SARATOGA COUNTY PUBLIC HEALTH SERVICES
COVID-19 TEST TO STAY PROGRAM
PARENT/GUARDIAN REPORTING FORM



Complete this form only if your child is participating in his/her school’s COVID-19 Test to Stay Program.

On days in-person learning is held, parents/guardians must perform the student’s COVID-19 test AND complete this reporting form before sending their child to school.

On days in-person learning is NOT held (including weekends, holidays, and snow days), parents/guardians must perform the student’s COVID-19 test AND complete this reporting form before 1PM.

Students with a positive COVID-19 test result should NOT be sent to school.

Students with symptoms of COVID-19 should NOT be sent to school, regardless of the test result.


BY CHECKING THIS BOX, YOU ACKNOWLEDGE THAT THIS FORM IS CONSIDERED AN OFFICIAL DOCUMENT AND YOU ARE SWEARING TO THE VERACITY OF THE INFORMATION YOU HAVE PROVIDED. YOU FURTHER ACKNOWLEDGE THAT MAKING A FALSE STATEMENT ON THIS FORM OR SUBMITTING ANY DOCUMENTATION IN SUPPORT THAT IS FALSE MAY BE PUNISHABLE AS A CRIMINAL OFFENSE. SCPHS MAY VERIFY THE INFORMATION YOU HAVE PROVIDED AND MAY CONTACT YOU FOR ADDITIONAL INFORMATION. *

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