Covid 19 Testing Consent Form 2022-2023

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Dear Parents/Gaurdians,

This form is for you to complete if you would like to give us consent to test your child here at South Seneca Middle/High School for COVID-19. We utilize testing for asymptomatic and symptomatic students. In the health office we are using rapid antigen testing, which will give us results in 15 minutes. This is not the PCR testing that gets sent off to a lab. The test is a non-invasive nasal swab that the child can perform independently or the RN can assist. We must have permission to be able to test your child at school. Once you sign this form, you give us permission to test for the remainder of the school year when we determine it is necessary. Most of the time it will be when they are coming into the health office complaining of symptoms and/or need to be screened related to a recent exposure.

Covid Info

-We are NOT quarantining students related to exposures unless you develop symptoms.

-Students and/or staff will be REQUIRED to isolate for 5 days if they test positive. Day 0 is counted as the day symptoms start or the day you test positive. Students may return to school after their isolation of 5 days, as long as symptoms are resolving and they have been 24 hours fever free without the use of fever reducing medication.

-Please, make the health office aware of any illness related symptoms at home and home testing should be done if your are able to. If you test positive at home- PLEASE notify the health office.

-If you need to bring your child into the health office, even if they are absent that day, we can accommodate COVID testing- please call us to make an appointment.

Please don't hesitate to reach out to us in the health office with any questions or concerns.

607-869-9636 x4151 or4102

Email *

First Name *

Last Name *

Date of Birth *

YYYY

Parent name and phone number *

Street Address, Town, State, and Zip Code *

If you want to be present during the testing please check yes or no. If yes- we will call you to come into the school to perform the test. *

YES

Required

I give consent for the child named at the top of this form to be tested for COVID-19.

By signing below, I attest that I am legally authorized to make decisions for the child named above.

By signing below, I consent that the school may notify the child named above and myself of the test results.

By signing below, I consent for the child named above to be tested by school staff, contracted healthcare personnel, local health department staff, and/or other trained personnel as directed by the school.

By signing below, I understand that test results will be shared with the Seneca County Health Department, and may be shared with the school, the ordering physician, and other permitted by law.

YES, I give Consent to Covid test my child.

NO, I do not give consent to Covid test my child.

I prefer to be called each time you want to test my child and get verbal consent

Other:

Required

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