COVID 19 Symptomatic Testing Consent Form for Berlin-Boylston Students 2022-2023
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Both vaccinated and unvaccinated individuals are encouraged to participate in symptomatic testing in the 2022-2023 school year.

Providing consent for symptomatic COVID 19 testing in the Berlin-Boylston schools in the 2022-2023 school year includes the following consent stipulations:

1.   Confirmation that I am the appropriate parent, guardian, legally authorized individual, or student of 18 years or older, to consent to the symptomatic COVID 19 testing program and to complete and submit this form for the student

2.    Voluntary participation: I understand that consenting to symptomatic COVID-19 testing is optional and that I can choose not to participate at any time. To cancel this consent, I need to inform my/my child's Principal in writing.

3.   Authorization and consent to collect a nasal swab sample from the student at school for symptomatic COVID-19 testing. 

4.   Authorization and consent to receive self-tests for at-home collection  (If self-tests are available and if recommended by School Nurse.)

5.   Authorization and consent to report positive test results and student's demographic information to the Department of Public Health. 

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Student's First Name
Student's Last Name
Student's Date of Birth  (MM/DD/YYYY)
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Student's Street Address
Student's Town/City of Residence
Student's Ethnicity
Student's Race
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Student's Gender
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I acknowledge that by entering my name below I am signing this consent electronically.
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