Consent form for COVID-19 testing

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This consent form is for participation in tests designed to detect asymptomatic coronavirus cases. Anyone experiencing symptoms should follow government guidelines to self-isolate, even if they have had a negative lateral flow test.

Consent relates to the following groups of students/pupils and staff as follows:

For students younger than 16 years - this form must be completed by the parent or legal guardian. Please complete one consent form for each child you wish to participate in testing.

Students over 16 who are able to provide informed consent - can complete this form themselves, having discussed participation with their parent/guardian if under 18.

For any pupil or student who does not have the capacity to provide informed consent - this form must be completed by the parent or legal guardian. Please complete one consent form for each child you wish to participate in testing.

The questions in this form refer to the student with the exception of the email address and contact details which will be used for sharing test results.

Link to privacy notice below

https://drive.google.com/file/d/1Dhr1Zm7XSKfAbHS58XHj232UVlDrJGd2/view?usp=sharing

Terms of consent:

1. 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 information provide week commencing 1st March 2021 and the attached Privacy Notice.

2. 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 If on the day of testing they do not wish to take part, then they will not be made to do so and consent can be withdrawn at any time ahead of the test.

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

4. 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testing I / they do not wish to take part, then I understand I / they will not be made to do so and that consent can be withdrawn at any time ahead of the test.

5. I consent that my child’s sample(s) will be tested for the presence of COVID-19.

6. I understand that if my child’s result(s) 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.

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

8. I understand that they will need to self-isolate following a positive lateral flow test result.

9. I agree that if my child’s test results are confirmed to be positive from this lateral flow test, I will report this to the school and I understand that my child will be required to self-isolate following public health advice.

10. I understand that if a close contact of my child tests positive that my child will self-isolate for 10 days in line with Government guidance.

Pupils first name *

Pupils last name *

School attended *

Year group *

Year 7

Year 8

Year 9

Year 10

Year 11

Year 12

Year 13

Year 14

Required

Gender – this information is needed for Department for Health and Social Care research purposes. *

Ethnicity - this information is needed for Department for Health and Social Care research purposes. *

Home Postcode *

Email Address – this is where test results will be sent. *

Mobile Number – this is where test results will be sent. Please do not put a landline number – you can only receive test results to a mobile number. *

Name of parent/guardian giving consent: *

Relationship to pupil: *

Signature (typing out your name is sufficient if you are filling in this form digitally): *

Todays date: *

YYYY

Currently showing any COVID-19 symptoms? *

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

I would like to select the following option for my child: *

I would like my child to self-swab on 3 occasions in school and under supervision, after the 3 tests I will then facilitate testing at home.

I would like my child to self-swab however I am not able facilitate testing at home, so would like my child to access the school test site for their twice weekly tests.

I would like my child to take part in testing, however he/she is unable to self-swab. I would like to attend school for training and to facilitate a test on site, after this time I will then carry out swabbing at home.

I would like my child to take part in testing, however he/she is unable to self-swab. I am unable to attend school for training, however I will watch the training video and read the step by step guide in order carry out swabbing at home. NB: A member of the school team will make contact with you to discuss this further.

Other:

Required

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