Consent for Student Rapid COVID-19 Testing

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Hope Hall School is seeking your consent to test your child for COVID-19 infection, in accordance with the NYS Micro-Cluster Strategy. If you consent, your child will receive a free diagnostic test for the COVID-19 virus. The law allows some information about your child to be shared with Monroe County and New York State Public Health Agencies, which may include notifying close contacts of your child if they have been exposed to COVID-19 and taking other steps to prevent the spread of COVID-19. A rapid COVID-19 test will be used, which will involve inserting a small swab into the front of the nose, which is not as invasive as the other COVID tests. If your child has a specimen collected for testing at school, we will send information home with them to let you know. Please complete a separate consent form for each child in your household by Friday, Nov. 13 at 4 p.m.

NYSDOH Requirements for Testing
In order to continue with in-person instruction, Hope Hall is mandated to test a new percentage of in-person students and staff each week, while under the Yellow, Orange and Red Zone Designations under the NYS Micro-Cluster Strategy.

If we are unable to meet this requirement, we will be required to move all students to fully-remote instruction.

Please enter today's date: *

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Student's full Name: *

By selecting "Yes" below, I attest that: I have signed this form freely and voluntarily, and I am legally authorized to make decisions for the child named in this form. I consent to my child being tested for COVID-19 infection. I understand that my child may be tested at multiple times during the 2020-21 school year. I understand that this consent form will be valid through June 30, 2021, unless I revoke such consent in writing. I understand that my child’s test results and other information may be disclosed as permitted by law. I understand that should my child test positive for COVID-19, they will not be permitted to return to school until they meet the Monroe County Health Department criteria for returning to school. I understand that should my child test positive for COVID-19, I must contact my child’s physician immediately to review the test results. *

Yes, I consent to having my child tested by Hope Hall School.

No, I do not consent to having my child tested by Hope Hall School

No, I do not consent to having my child tested by Hope Hall School, but will provide a test result for my child when requested.

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