In-school Lateral Flow Test Consent
Consent form for in-school testing in September 2021.

Privacy Notice: http://www.princesrisborough.bucks.sch.uk/docs/Parents/COVID-19/Privacy_Notice_for_Student_Covid_Testing.pdf

Terms of consent

1. I have had the opportunity to consider the information provided by the school/college about the
testing, ask questions and have had these answered satisfactorily, based on the information
presented in the newsletter dated [16/07/2021] and the attached Privacy Notice (above).

2. In the case of under 16s, I have discussed the testing with my child and my child is happy to
participate. If on the day of testing they do not wish to take part, then they will not be made to do so
and consent can be withdrawn at any time ahead of the test.

3. I consent to having / my child having a nose swab for lateral flow tests. I / my child will
self-swab if I / my child is able to otherwise I understand that assistance is available

4. I understand that there may be multiple tests required and this consent covers all tests for the
below named person. If, on the day of testing I / they do not wish to take part, then I understand I /
they will not be made to do so and that consent can be withdrawn at any time ahead of the test.

5. I consent that my / my child’s sample(s) will be tested for the presence of COVID-19.

6. I understand that if my /my child’s result(s) are negative on the lateral flow test I will not be
contacted by the school/college except where I am / they are a close contact of a confirmed
positive.

7. If the lateral flow test indicates the presence of COVID-19, I commit to ensuring that I / my child is
removed from school premises as promptly as possible, bearing in mind I / they may have some
anxiety following a positive test result.

8. I understand that I / they will need to self-isolate following a positive lateral flow test result.

9. I agree that if my / my child’s test results are confirmed to be positive from this lateral flow test, I
will report this to the school / college and I understand that I/ my child will be required to self-isolate
following public health advice.

10. I understand that if a close contact of my child tests positive that my child will self-isolate for 10
days in line with Government guidance.
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Email *
Student Year Group from September 2021 *
Student Form / House
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Student First Name *
Student Surname *
Student date of birth *
MM
/
DD
/
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Gender (**Please note this binary choice is dictated by government**) *
Ethnic Group *
Is the student over 16? *
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