Consent for Student Rapid COVID-19 Testing
Eastern Suffolk BOCES is seeking your consent to test your child for COVID-19 infection. If you consent, your child may receive a free diagnostic test for the COVID-19 virus. A rapid COVID-19 test will be used, which will involve inserting a small swab, similar to a Q-Tip, into the front of the nose. It includes a non-invasive nasal swab and a 15-minute waiting period to determine results. Following the results, each individual will have their results and any necessary follow up explained to them. This testing is for asymptomatic (healthy) individuals only.

Upon completion of this form, your child will be notified of their testing appointment.
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Student First Name *
Student Last Name *
Student Date of Birth *
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Please indicate which session your child attends at WTC: *
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Please indicate which Ward Technical Center Program that your child attends: *
Required
The law requires and/or allows some information about your child to be shared with Suffolk County and New York State Public Health Agencies. This includes notifying the Suffolk County Department of Health about the COVID-19 results of each student who is tested, including the student’s name, date of birth, race, ethnicity, gender, address, phone number, and result of the COVID-19 test. By acknowledging/signing below, I attest that: *
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 First and Last Name of Parent/Guardian *
Parent/Guardian Email Address
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