Covid-19 Consent Forms for Students Under 18

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To be completed by parent or guardian. Completion of this form gives consent for your minor student to participate in testing COVID-19 at Earle School District.

Today's Date mm/dd/yyyy format *

YYYY

First Name *

Last Name *

Student email *

Student Phone number *

Student Date of Birth: must be mm/dd/yyyy format *

YYYY

Student Current Age *

Student School *

Earle Elementary

Earle High School

Student Grade *

Your name *

Your relationship to student *

Parent/Legal Guardian Name *

Street Address *

City *

State *

Zip Code *

Your phone number *

Your email address *

Completion of this form confirms your understanding of the following: Binax tests will be used for students who are wishing to come back early from quarantine. They will not be utilized for random symptomatic people, but will be used to determine early return from quarantine. If you choose to utilize the BINAX for early return from quarantine, we ask that you do so on day 7 (or as close to day 7 as possible). Your student will participate in Binax COVID-19 testing at Earle School District at no charge to the student. If you do not wish for your student to test with Earle School District, your student may obtain testing at an alternate site, at your expense. The nurse will notify both you and your student of the results via phone or at testing site. The results will be determined within 15 minutes. If the Student and parent/guardian should leave before getting results, then they must be prepared to answer their phones in order to receive test results, otherwise school staff may be used to make contact with the student. *

I understand and consent to the above for my student. Completion of the this form confirms your understanding

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