Lateral Flow Test Consent Form

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This form provides consent to allow your child to self test for Covid -19 while at Derby Moor Academy.

Name of person completing this form *

Relationship to student *

Please provide your email address: *

Child's first name: *

Child's surname: *

Child's date of birth: *

YYYY

Child's year group *

Child's tutor group (if known)

Consent - Please read

Please read the information that follows before completing the boxes below.

For students younger than 16 years - this part of the form must be completed by the parent or legal guardian. Please complete one consent form for each child you wish to enrol for testing.

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

1. I have had the opportunity to consider the information provided by Derby Moor Academy about the testing, ask questions and have had these answered satisfactorily, based on the information received from Derby Moor Academy.
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 If on the day of testing they do not wish to take part, then they will not be made to do so and consent can be withdrawn at any time ahead of the test.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 a lateral flow test.
4. I consent that my / my child’s sample(s) will be tested for the presence of COVID-19.
5. I understand that if my child / my result(s) are negative on the lateral flow test I will not be contacted by the school/college except where they/you are a close contact of a confirmed positive.
6. If the lateral flow test indicates the presence of COVID-19, I consent to my child having / having a nose and throat swab for confirmatory PCR testing, which shall be sent the same day to an NHS Test & Trace laboratory.
7. I consent that I / they will need to self-isolate following a positive lateral flow test result, conducted at Derby Moor Academy or until the results of the confirmatory PCR test have been received if the test has been carried out at home.
8. 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.
9. I consent that if a close contact of my child tests positive, or is awaiting results of a PCR test, my child will self isolate as per government guidance.

Having read the information above i give consent for my child to participate in Lateral Flow Testing. *

Yes

In the event of a positive Lateral Flow Test please provide a contact phone number I can be contacted on. *

Submit

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