The Onteora Central School District (OCSD) is seeking your consent to test your child for COVID-19 infection to the extent such testing is required by New York State for in-person attendance at school per Executive Order and/or the NYS Cluster Action Initiative and/or Guidance issued by the NYS Department of Health (NYSDOH). If you consent, your child may receive a free screening for the COVID-19 virus that will be administered by a licensed medical professional (Dr. Neal Smoller & staff or a School Nurse). A rapid COVID-19 test will be used. A rapid test involves inserting a small swab, similar to a Q-Tip, into the front of the nose. You will be notified if your child tests positive for COVID-19. Any students who test positive will be sent home and must be kept at home until meeting the Ulster County Department of Health criteria to return to school. Please contact your child's doctor immediately to review the test results should your child test positive for COVID-19.
By consenting, you further agree to disclosure of certain personally identifiable information about your child to New York State Public Health Agencies and any third-party entities, contractors or consultants utilized by OCSD to facilitate testing, if your child tests positive. This includes, but is not limited to, notifying the Ulster County Department of Health and/or NYSDOH about the COVID-19 results of each student who is tested, including the student's name, date of birth, race, ethnicity, gender, address, phone number, and result of the COVID-19 test.

By digitally signing below, I attest that:
• I have signed this form freely and voluntarily, and I am legally authorized to make decisions for the child named above.
• I authorize the Onteora Central School District to test my child for COVID-19 infection as such testing may be required pursuant to Executive Order and/or the State's Cluster Action Initiative and/or NYSDOH Guidance.
• I understand that my child may be tested at multiple times during the 2021-2022 school year pursuant to State requirements and/or guidance for in-person attendance at school.
• I understand that this consent form will be valid through June 30, 2022, unless I revoke such consent in writing.
• I understand that OCSD's testing program could involve the disclosure of my child's Personally Identifiable Information, including my child's name, COVID-19 test result, date of birth, race, ethnicity, gender, street and/or email address, and phone number(s) and I consent to the disclosure of the same to the agencies and/or entities described above for the purposes outlined herein. I further authorize my child's test results and other information to be disclosed to any governmental entity as may be required or permitted by law.
• I acknowledge that a positive test result will require my child to be sent home from school and remain at home until he/she meets the criteria to return to school according to the Ulster County Department of Health.
 
I understand that this testing does not replace treatment by my child's medical provider, and I assume complete and full responsibility to take appropriate action regarding my child's test results. I agree that I will seek medical advice, care, and treatment for my child from his/her medical provider if I have questions or concerns or if my child  becomes ill or their condition worsens.
I agree to allow any positive test results to be forwarded via fax to my child's primary care physician.
I understand that, as with any medical test, there is the potential for a false positive or false negative COVID-19 test result.
I understand that if I am a student age 18 or older or may otherwise legally consent for my own health care, references to "child" or "my child" refer to me and I may sign this form on my own behalf.

        ***   Please fill out a separate form for each child in your household attending OCSD in-person. ***