Southfields Academy NHS Test and Trace Consent Form for COVID-19 Testing
This form is to be completed by the parent or legal guardian of the pupil.
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1. First Name of Pupil *
2.Surname of Pupil *
3. Year Group of Pupil *
4.Date of Birth of Pupil *
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DD
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5.Gender at Birth of Pupil *
6.Home Postcode of Pupil *
7.Name of Parent *
8.Relationship to the Child *
9.Email address (please note this will be the email we will use to notify you of any results where appropriate) *
10.Mobile Phone Number (please note this will be the number we will use to contact you with any results where appropriate) *
11.I have had the opportunity to consider the information provided by the school about the testing, ask questions and have had these answered satisfactorily, based on the information presented in the letter dated *
12.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  If on the day of testing they do not wish to take part, then they will not be made to do so and consent can be withdrawn at any time ahead of the test. *
13.I consent to my child having a nose and throat swab for a lateral flow test. *
14.I consent that my child's samples will be tested for the presence of COVID-19. *
15. I understand that if my child's results are negative on the lateral flow test I will not be contacted by the school except where they are a close contact of a confirmed positive test. *
16.If the lateral flow test indicates the presence of COVID-19, I understand that I will need to arrange a PCR test from a local test site to confirm the result. *
17.I understand that my child will need to self-isolate following a positive lateral flow test result, until the results of the confirmatory PCR have been received. *
18.I agree that if my child's test results are confirmed to be positive from this PCR test, I will report this to the school and I understand that my child will be required to self-isolate following public health advice. *
19.I consent that if a close contact of my child tests positive but my child has tested negative, they will continue to attend school but will be tested every day at school for 7 days.
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I consent that the Academy can submit the first line of my child's home address, postcode and my mobile telephone number to the DfE LFD Testing Service (please note this data will only be used to communicate the results of your child's test to you).  If you select 'No' we will submit the school's contact details for your child.
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