MHS COVID19 Testing Consent Form
We are seeking your consent to test your child for COVID-19 infection.   Mundelein Consolidated HS District 120 has partnered with the University of Illinois (“Testing Partner”) to test D120 students, teachers, and staff members for COVID-19 infection. If you do not consent to your child being tested for COVID-19, your child will not be allowed to participate in the testing process.

We are arranging for our Testing Partner to test the students at least once per week.

If you consent, your child will receive a free diagnostic test for the COVID-19 virus conducted by collecting saliva (spit).

MHS District 120 will receive results of your child's test and will ensure notification of any positive result.

If your child’s test results are positive, please contact your child’s doctor immediately to review the test results and discuss next steps. You may not send your child back to school without a note from your child’s doctor that indicates your child is no longer positive for the COVID-19 virus.
 
If your child’s test results are negative, this means that the COVID-19 virus was not detected in your child’s saliva (spit).

Tests sometimes produce incorrect negative results called “false negatives” in people who have COVID-19.  If your child tests negative but has symptoms of COVID-19, or if you have concerns about your child’s exposure to COVID-19, you should call your child’s doctor.

MHS District 120 and the Illinois Department of Public Health (“IDPH”) will also receive your child’s test results, consistent with IDPH guidance and the Illinois Control of Communicable Disease Code.  

If you are willing to provide consent for your child to be tested, please complete this questionnaire.  Parents/Guardians and child will receive a future communication from MHS District 120 regarding when testing will begin.

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Parent/Guardian First Name *
Parent/Guardian Last Name *
Parent/Guardian address *
Parent/Guardian Tel./Mobile # *
Parent/Guardian Email Address *
Best way to contact you: *
Student First Name *
Student Last Name *
Student ID number *
Student Grade *
Do you have another child you wish to provide consent for?
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