COVID-19 Home Test Result Reporting

COVID-19 Home Test Result Reporting

- ONE FORM PER DPS 109 STUDENT -
Student's School: *
Early Learners - please select South Park Elementary School from the above drop-down menu.
Student's Name (as it appears in Skyward Family Access) *

First Name Last Name
Parent/Guardian Name *

First Name Last Name
Parent/Guardian Phone Number *
Home Test Manufacturer(Brand) and Test Name *
Please type in the information on the at-home test. Ex. Abbott BinaxNOW
COVID-19 Test Date *
COVID-19 Test Result *

Negative Positive
TEST RESULTS: Please use the 'Take A Photo' button or 'Upload Photo' tool below to provide a photo of your child's test results.

Example:
Take Photo of Result
Upload Photo Instead

Cancel of
IF YOUR CHILD TESTS POSITIVE A DPS109 STAFF MEMBER WILL CONTACT YOU VIA THE NUMBER PROVIDED ABOVE. PLEASE DO NOT SEND YOUR CHILD TO SCHOOL.
Parent/Guardian Signature *

Clear
Should be Empty: