Student Consent Form: COVID-19 Pooled Testing

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To be completed by parent or guardian.

You will not be notified of pooled test results, but you will be notified of individual follow up test results either via phone or email.

If you have more than one student attending the North Adams Public Schools, you will need to complete a separate consent for each child.

Click here to view the printable version of the form: https://5il.co/pj19

Please begin by entering the Parent/Guardian email address:

Email *

Parent/Guardian Full Name: *

Parent/Guardian Cell/Mobile #: *

Child/Student Name (Last name, First name): *

Student's School: *

Student's Grade Level: *

Student's Date of Birth: *

YYYY

Student's Age: *

Student's Classroom (if applicable):

Have the student listed above been diagnosed with COVID-19 in the past 90 days?: *

Yes, my student has tested positive for COVID-19 in the past 90 days

No, my student has not tested positive for COVID-19 in the past 90 days

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