2022-23 Cville Schools Permission Form for COVID Testing Program for Staff and Students (One-Time and Weekly)

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To help keep our schools safe, Charlottesville City Schools is partnering with the Virginia Departments of Health and Education to provide free PCR testing for COVID.

This form covers one-time testing (such a following exposure or symptoms) as weekly in-school testing. You can sign up for one or both.

If you sign up just prior to a testing event, pre-printed labels may not be available and you may not get a follow-up email telling you that the results are negative. (Any positive cases receive a phone call.) Late registrations can usually be tested, however (following the policies of our vendor.)

NOTE: Each week, registration ends on Friday afternoon. Late registrants can typically be tested (following our vendors' protocols), but pre-printed labels will not be available, and they will receive that week's email indicating negative test results.

Learn more at charlottesvilleschools.org/covid-testing.

First Name of Person to be Tested *

Last Name of Person to be Tested *

Role of Person to be Tested *

Student Younger than Age 18 (form must be submitted by parent or guardian)

Student Older than Age 18 (form can be submitted by student)

Staff Member

Approved School Volunteer or Partner

Testing Permission Type *

--Weekly in-school testing
--One-time testing (such as for a special event or -- if available -- after an exposure/symptoms)
--Both

I give permission for both weekly testing and for special one-time testing events.

I give permission for one-time special testing events or (if available) after exposure/symptoms/diagnosis.

I give permission for weekly, in-school testing.

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