Student Informed Consent for COVID-19 Testing
Please carefully read the informed consent and then complete the information below. You must complete on these consent forms for every child in your household who attends school in the hybrid in-person instructional model.

As a reminder, if you completed and returned to school the Student Informed Consent form that was mailed to your home you DO NOT  need to also complete this online form.

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Student Informed Consent for COVID-19 Testing
1. I understand that the Buffalo Public School District requires a signed consent for COVID-19 testing of my child. I understand I need to sign a consent before my child under the age of 18 can be tested. I authorize Buffalo Public School District, an independent laboratory, to conduct collection and testing for COVID-19 through nasal swab ordered by an authorized medical provider or public health official of my child.  I understand that this testing is voluntary and that my child is not required, nor am I required, to authorize my child to undergo such testing as a condition to attend school.

2. I authorize the my child's test results to be disclosed to Buffalo Public School District and any applicable county, state, or other governmental entity as required by law and understand that such disclosure will also be made consistent with applicable law.

3. I acknowledge that a positive test result indicates that my child and I, and members of our family, must abide by isolation and quarantine protocols and all applicable federal, state, and/or local guidance on isolation and quarantine to avoid infecting others.

4. By signing this document and agreeing and authorizing my child to undergo COVID-19 testing, I understand that I am not creating patient relationship for m child or for me with the school district. I understand that the Buffalo Public School District is not acting as my child's medical provider.  Testing does not replace treatment by my child's medical provider. I assume complete and full responsibility to take appropriate action with regards to my child's test results. I agree I will seek medical advice, care, and treatment from my child's medical provider if I have questions or concerns or if my child's condition worsens.

5. I understand that COVID-19  testing has the potential for false positive or false positive test results to occur. I understand that in the case of a positive test result, I will need a letter from my child's health care provider for my child to return to school.
Student First Name *
Student Last Name *
Student Date of Birth *
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School Name *
Student Grade Level *
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Parent First Name *
Parent Last Name *
Parent/Guardian Home Address *
Parent Telephone Number *
Today's Date *
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