NHS Test and Trace consent form for COVID-19 testing: HFCS

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Terms of consent

1. I have had the opportunity to consider the information provided by the school/college about the testing, ask questions and have had these answered satisfactorily, based on the information provided to me and the Privacy Notice available on the Holy Family Catholic School Website.

2. I consent to my child to having a nose and throat swab for lateral flow tests. I will ensure my child will self-swab if they are able to otherwise I understand that assistance is available.

3. I understand that there may be multiple tests required and this consent covers all tests for the below named person. If, on the day of testing I do not wish them to take part, then I understand they will not be made to do so and that consent can be withdrawn at any time ahead of the test.

4. I consent that the sample(s) will be tested for the presence of COVID-19.

5. I understand that if the result(s) are negative on the lateral flow test I will not be contacted by the school/college except where the below named person is a close contact of a confirmed positive.

6. If the lateral flow test indicates the presence of COVID-19, I commit to ensuring that the below named person am removed from school premises as promptly as possible, bearing in mind they may have some anxiety following a positive test result.

7. I consent that the below named person will need to self-isolate in line with Government guidelines following a positive lateral flow test

Pupil First Name *

Pupil Last Name *

Pupil Year *

Pupil Form *

Pupil Date of Birth *

年

月

日

Pupil Gender *

Female

Male

Pupil Ethnicity *

Prefer not to say

Bangladeshi

Chinese

Indian

Pakistani

Another Asian Background

Asian or Asian British

African

Caribbean

Another Black Background

Black, African, Back British or Caribbean

Asian and White

Black African and White

Black Caribbean and White

Another mixed background

Mixed or Multiple Ethnic Groups

British, English, Northern Irish. Scottish or Welsh

Irish

Irish traveller or gypsy

Another white background

White

Arab

Another ethnic background

Another ethnic group

Is Pupil currently showing any COVID-19 symptoms? *

Yes

Has the pupil had the Covid-19 Vaccine? *

Yes - First Dose

Yes - Both Doses

Home Postcode *

First line of address *

E-mail address *

This is the e-mail where your test result will be sent.

Mobile Number *

This is the number where your test result will be sent.

Details of any health or accessibility issues which might affect safe participation in the testing exercise.

Parent/Carer Signature *

Please type your full name to confirm your consent.

I do / do not give consent

Yes - I give consent

No - I do not give consent

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Please note you will need to complete one form per pupil. Once you press submit ,you will be able to fill out another form if you need to.

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