NHS Test & Trace Consent form for COVID-19 testing (Queensbridge School) Testing, Privacy and face coverings. Please complete forms no later than Monday 1st March 2021.

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This common consent form has been designed for use by parents and guardians of pupils and under 16s, pupils and students over 16.

• For pupils and students younger than 16 years - this form must be completed by the parent or legal guardian.

Please complete one consent form for each child you wish to enrol.

• Pupils and students over 16 can complete this form themselves, having discussed participation with their parent / guardian if under 18.

Please carefully read and complete the following:

Terms of consent1. I have had the opportunity to consider the information provided by the school/college about the testing, ask questions and have had these answered satisfactorily, based on the information presented in the letter dated 6th January 2021 and the attached Privacy Notice. 2. In the case of under 16s, I have discussed the testing with my child and my child is happy to participate. If on the day of testing they do not wish to take part, then they will not be made to do so and consent can be withdrawn at any time ahead of the test. 3. I consent to having / my child having a nose and throat swab for lateral flow tests. I / my child will self-swab if I / my child is able to otherwise I understand that assistance is available. In the case of under 16s or pupils who are not able to provide informed consent, I have discussed the testing with my child and they are happy to participate and self-swab (with assistance if required).4. I understand that there may be multiple tests required and this consent covers all tests for the below named person. If, on the day of testing I / they do not wish to take part, then I understand I / they will not be made to do so and that consent can be withdrawn at any time ahead of the test.5. I consent that my / my child’s sample(s) will be tested for the presence of COVID-19.6. I understand that if my /my child’s result(s) are negative on the lateral flow test I will not be contacted by the school/college except where I am / they are a close contact of a confirmed positive.7. If the lateral flow test indicates the presence of COVID-19, I consent to having / my child having a nose and throat swab for confirmatory PCR testing. I/they will follow the instructions on the PCR Kit to return the test the same day to an NHS Test & Trace laboratory. 8. If the lateral flow test indicates the presence of COVID-19, I commit to ensuring that I / my child is removed from school premises as promptly as possible, bearing in mind I / they may have some anxiety following a positive test result.9. I consent that I / they will need to self-isolate following a positive lateral flow test result, until the results of the confirmatory PCR have been received.10. I agree that if my / my child’s test results are confirmed to be positive from this PCR test, I will report this to the school / college and I understand that I/ my child will be required to self-isolate following public health advice.11. I consent that if a close contact of my child tests positive but I / my child has tested negative, I / they will continue to attend school / college but will be tested every day at school / college for 7 days. 12. I have read and accept the privacy notice.

Declaration of consent: By clicking here, I agree with all the above statements and confirm it is correct thereby giving consent for my child to take part in the in-school testing at Queensbridge School.

Name

Last name

Year group

Date of Birth

YYYY

Has your child travelled to any countries outside of the UK and Ireland within the last 14 days?

Yes

Clear selection

Has your child had a coronavirus vaccines?

Column 1

Yes - they've had one dose

Yes - they've had two doses

Clear selection

All staff and pupils will wear face masks. Please indicate if your child is exempt and provide the reason in the next question. Please put NA if this does not apply to your child.

My child is exempt

Clear selection

Face covering exemption. Please put NA if this does not apply to your child.

A physical or mental illness or impairment or disability

Putting on wearing or removing a face covering will cause my child severe distress

I will be contacting the school to give details of any other exemption not listed above

Clear selection

Email address (this is where test results will be sent)

Mobile number - this is where test results will be sent. Please do not put a landline - you can only receive the test results to a mobile number.

Name of parent/guardian giving consent

Relationship to the test subject

Signature - typing your name is sufficient if you are filling in this form digitally

Today's date

YYYY

Submit

Clear form

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