Overview:
By giving your permission, your minor (“Minor” or “Test Taker”) will be able to receive a free rapid screening test (COVID-19 antigen test). Antigen tests can detect cases of COVID-19 before students are known to be symptomatic, allowing health staff to make informed decisions to limit transmission within schools and help families to minimize learning disruptions. Routine screening shows if your minor in particular is sick. The antigen tests offered through this program are FDA-authorized.

Key highlights of the document are:
- Like most COVID-19 tests, the tests used in this program are FDA-approved. (Note: The word “approved” means a very specific thing in the eyes of the FDA. As of early 2021, no COVID-19 tests have been approved by the FDA.)

- Individual diagnostic tests may be used as “follow-up tests” if a screening test produces a positive result. They may also be used on their own. Your school or organization will contact you to determine when and how diagnostic testing can be used.

- Since antigen tests do provide individual results, each family will be notified of all results from every screening test their minor performs.

- Antigen testing may create Protected Health Information (PHI). We protect this information and only share it when required (e.g. with public health authorities).

- Your consent can be changed at any time.

- Potential risks from collecting a sample include slight discomfort.

By completing and submitting this consent, I confirm that I am the appropriate parent, guardian, or legally authorized individual to provide consent for the Test Taker and:

A. I authorize the collection and testing of an individual antigen test as requested by Test Taker’s organization or school on the Test Taker. I understand that all sample types will be non-invasive, short nasal swabs or saliva. Potential risks from sample collection include discomfort from the insertion of the swabs. The irritation is expected to be brief.

B. I understand that individual antigen tests used by Yadkin County Schools are FDA authorized under an emergency use authorization.

C. I understand that I will be notified about the results of any individual antigen test for COVID-19.

D. I understand that, as with any COVID-19 test, there is the potential for a false positive or false negative COVID-19 test result.

F. I understand that the Test Taker’s school or Organization is acting as the Test Taker’s medical provider, this testing does not replace treatment by the Test Taker’s medical provider, and I assume complete and full responsibility to take appropriate action with regards to the Test Taker’s test results. I will not make medical decisions without consulting a healthcare provider or disregard medical advice from my healthcare provider or delay seeking such advice based on the test results I receive from individual testing.

G. I understand that follow-up testing may create protected health information (PHI) and other personally identifiable information of the student. Pursuant to 45 CFR 164.524(c)(3), I authorize and direct the Test Taker’s school or Organization to transmit such PHI information to the applicable state departments of public health and department education, and the testing provider as appropriate. I understand that authorizing the above mentioned testing is optional and that I can refuse to give this authorization, in which case, the test taker will not be tested.

H. I understand that I can change my mind and cancel this permission at any time, but that such cancellation is forward-looking only, and will not affect information I already permitted to be released. To cancel this permission for COVID-19 testing, I need to contact the Test Taker’s School or Organization.

I have read the above information about the screening program, the description of the test samples to be collected, and possible risks of the program and I understand that this information may also be provided to me by the Test Taker’s school or Organization upon written request to the school/organization. I voluntarily agree to allow Test Taker as a minor to participate in individual testing as applicable.