AUTHORIZATION/CONSENT TO COVID TESTING
Nickerson / South Hutchinson USD 309 is participating in a modified in-school quarantine option under recommendation and guidance from KDHE. It is called Test to Learn/Test to Play because it provides a way for students to safely continue to attend school and participate in activities while in quarantine, thereby supporting academic success and social/emotional health. To participate, the student must meet eligibility criteria, and parents must consent for the student to (for the duration of the quarantine) wear a mask when indoors and be tested daily with a nasal swab Binex Now Antigen Rapid Test . The student will not be in close contact with other students or staff at school until a negative test result is known each day of the quarantine. These students will not be allowed to ride the bus to school during this timeframe.

*Those who do not consent to participate will complete their quarantine at home.

Please carefully read the following informed consent for COVID-19 testing at school:

- I understand the COVID-19 testing options available to my child and authorize Nickerson / South Hutchinson USD 309 to conduct specimen collection and testing for COVID-19 for my child through a nasal swab collection as ordered to be a part of the Test to Learn/Test to Play modified quarantine.  

- I understand my student may NOT ride the bus to school to be tested each morning.

- I understand and agree that in order to participate in Test to Learn/Test to Play modified quarantine, my child must wear a mask when indoors at school and be tested daily with a nasal swab Binax Now Antigen Rapid Test for the duration of the modified quarantine.

- If my child has a specimen collected for testing at Nickerson / South Hutchinson USD 309, the school will notify me of the test results via my contact information provided on this consent form using non-secure methods (email, etc.), and I understand the risks involved.  

- I authorize the test results to be disclosed to the school district Point of Contact in collaboration with the Reno County Health Department and Kansas Department of Health and Environment.

- I acknowledge that a positive test result is an indication that my child must self-isolate to avoid infecting others for a minimum of 10 days.  

- I also agree to assist the school with identification of any close contacts which occurred within the 48 hours prior to test sample collection.  

- I understand that Nickerson / South Hutchinson USD 309 is not acting as my child’s medical provider, this testing does not replace treatment by my child’s medical provider, and I will seek medical advice, care and treatment from my child’s medical provider if I have questions or concerns.

- I understand that, as with any medical test, there is the potential for a false positive or false negative COVID-19 test result and that Nickerson / South Hutchinson USD 309 will collaborate with the Reno County Health Department for testing guidance and recommendations as needed.  


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Email *
Parent/Guardian Name (First and Last) *
Parent/Guardian Email *
Student's First Name *
Student's Last Name *
My student meets ALL of the following criteria for eligibility: *
Required
Building of attendance for student engaging in alternate testing *
What grade is your student in? *
If your student in in PreK to 6th grade, who is their classroom teacher (grades 7-12 can skip this question)
By typing my name below, I certify that I have been informed about the test(s) purpose, and voluntarily agree to allow my child to be tested for COVID-19.   *
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