Derby Pride Academy
LATERAL FLOW TESTING CONSENT FORM FOR PARENTS
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Consent form for COVID-19 testing
This consent form has been designed for use by parents and guardians of pupils.  
For pupils younger than 16 years, the parent or legal guardian must complete this form.
Pupils over 16 can complete this form themselves, having discussed participation with their parent / guardian if under 18.

By completing this form you are consenting to your child having a nose swab for a lateral flow test.
Name of pupil to be tested *
Name of parent or guardian if under 16 *
Signature *
Date *
MM
/
DD
/
YYYY
Relationship to child if under 16 *
Your email address for confirmation *
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