I/We say that I/we am/are the parent(s)/guardian(s) of the student named above or that I am the staff member named in questions 1 and 2. I/we understand that the Beacon City School District will rely on this form to establish whether consent has been granted for the District to perform COVID-19 testing on the above identified student or staff member. I/We hereby consent to my child or myself (if a staff member) being tested and for the test results to be provided to the District as well as appropriate and state health authorities. By digitally checking Yes/Si below, I attest that: I have signed this form freely and voluntarily, and I am legally authorized to make decisions for the employee/student named above. I authorize the Beacon City School District to test for COVID-19 infection. I understand that employees/students may be tested at multiple times during the 2020-2021 school year. I understand that this consent form will be valid through June 30, 2021, unless I revoke such consent in writing. I authorize that test results and other information be disclosed for public health purposes to any governmental entity as may be required or permitted by law. I acknowledge that a positive test result will require employees/students to be sent home from school and remain at home until I/they meets the criteria to return to school according to the Dutchess County Department of Public Health. I understand that this testing does not replace treatment by a medical provider, and I assume complete and full responsibility to take appropriate action regarding test results. I agree that it is my responsibility to seek medical advice, care, and treatment for myself/my child from my/their medical provider if I have questions or concerns or if I/they become ill or my/their condition worsens. I understand that, as with any medical test, there is the potential for a false positive or false negative COVID-19 test result. *
