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NHS Test and Trace consent form for COVID-19 testing
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* Indicates required question
Email
*
Your email
Forename of student to be tested
*
Your answer
Surname of student to be tested
*
Your answer
Year group
*
Year 7
Year 8
Year 9
Year 10
Year 11
Year 12
Year 13
Required
Tutor group
*
Your answer
Date of birth. Please use this format DD/MM/YYYY
*
Your answer
Gender
*
Male
Female
Required
Ethnicity
*
Asian or Asian British
Black, African, Black British or Caribbean
Mixed or multiple ethnic groups
White
Prefer not to say
Required
Is the person receiving the test currently showing any of the 3 main COVID-19 symptoms?
*
Yes
No
Home postcode
*
Your answer
First line of address
*
Your answer
Mobile phone number - this is where test results will be sent. Please do not provide a landline number
*
Your answer
Email address - this is your preferred email address where test results will be sent.
Your answer
Please type out your name as a signature for the form as confirmation of consent
*
Your answer
Details of any health or accessibility issues which might affect a child's safe participation in the testing exercise. Please leave blank if N/A
Your answer
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