Consent for Asymptomatic COVID Testing HS/BP, Grimshaw- January 13, 2021

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LaFayette CSD will provide asymptomatic COVID testing for students, when testing resources are made available.

Onondaga County Department of Public Health (“DPH”) has authorized and is training personnel to administer this initial rounds of surveillance testing to evaluate the scope of COVID-19 within a population. By consenting to have the test performed on your child, you are authorizing personnel to perform the BINAX NOW Antigen test, gather the data and to transmit the test findings to the DPH, NYSDOH and New York State Department of Education to assist with their efforts to control the spread of COVID-19. You will be contacted by the school if your child’s test results are positive. If your child’s result is positive, then you must pick up your child from school, contact your child’s primary health care provider to discuss your child’s health care needs, whether further testing is recommended and quarantine restrictions.

The test will be administered using a nasal swab that is inserted just inside of the nasal cavity.

You will also need to complete a brief registration form for testing.

Please register at the following website: https://covid19.ongov.net/appointments/school-registration-form/

Please select the building your student attends *

Grimshaw Elementary

LaFayette Big Picture School

LaFayette Junior Senior High School

Participant Information

Student First Name *

Student Last Name *

Grade *

Parent/Guardian Information

Parent/Guardian First Name *

Parent/Guardian Last Name *

Relationship to Student: *

Home Phone *

Cell Phone *

Agreements

For each of the agreements below, please read the terms, check the box to mark your acknowledgement, and type your name to confirm your agreement.

Please choose one of the options: *

Yes, I agree: I give my consent for my child to be tested for COVID 19 on January 13, 2021 for the testing sample to be submitted to the district.

No, I do not agree: I DO NOT give my consent for my child to be tested.

Please type your name to confirm (Parent/Guardian Name who is 18 years of age or older) *

Please be sure to register your child for testing: https://covid19.ongov.net/appointments/school-registration-form/

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