I authorize for myself/my minor child for Secure Alliance PS and its associated professionals to collect my personal and medical information as documented above. In addition, I authorize the Secure Alliance PS and its associated professionals to communicate with the county health department as required.

I also understand that my/my minor child's personal and medical information is confidential and will only be disclosed to third parties with my permission and that by participating in COVID screening for the event I am attending, I am granting Secure Alliance PS authorization to communicate information including the test results and my/my minor child's collected demographic information with the health department including the Tacoma Pierce County Health Department and the Washington State Department of Health.

I further understand that this COVID Screening is a Rapid Antigen test and that my participation in this screening includes a witnessed self administration of the test. I agree to hold harmless the promoter of the event and Secure Alliance PS for my/my minor child participation in this screening. I also agree that the results of this screening can only be used to attend the on-site event on this day.

COVID-19 is a dangerous infectious disease that is spread primarily from person to person through respiratory droplets.
Close proximity to others presents a risk of infection and disease spread. It is recommended that persons maintain six
feet of distance between one another at all times; however, the infection may still occur when this distance is maintained, and this distance is not always maintained. To prevent the spread of COVID-19, testing, contact tracing, and isolation of infected people supports the health and safety of the community.
I authorize this testing unit to conduct collection and testing for COVID-19 through a nasal swab—less than one inch into the nostril—to screen for COVID-19.
****If I/my minor child receive(s) a positive result:
I agree to isolate myself/my child for at least 10 days and to seek medical attention for further instructions and to receive a PCR test if necessary.
I understand my/my minor child test results will go to the health departments in my county or state or to any other governmental entity the law requires.

Acknowledgments:
I assume complete and full responsibility to take appropriate action with regard to my/my minor child's test results. I acknowledge a positive test result is an indication I /my minor child must self-isolate and wear a mask or face covering as directed to avoid infecting others. I understand, as with any medical test, this COVID-19 test has the potential for false-positive—test is positive but I do not have the infection—or false-negative—test is negative but I have the infection—results. I agree I will seek medical advice, care, and treatment from my/my minor child's healthcare provider if I have questions or concerns, or if my /my minor child's) condition worsens. I understand the testing unit is not acting as a healthcare provider and that this testing does not replace treatment by a healthcare provider. I further agree to hold harmless the event promoter and the testing service company for any harm related to self-directed testing.

I understand the test purpose, procedures, possible benefits, and risks, and I can request a copy of this consent form. I can ask questions before I sign this consent form, and I understand I can ask additional questions or revoke my/my minor child's consent at any time during the testing process.

I have read the contents of this form in its entirety and voluntarily consent for me/my minor child to undergo diagnostic testing for COVID-19 for the purpose of attending an event.