Covid 19 Testing - Consent Form
Please complete by MONDAY 26th JULY to help us plan
Students in Years 7 to 12
One consent form to be completed by the parent/person with parental responsibility for each child being tested.
Student Name
*
First Name
Last Name
Year group
*
Student Date of Birth
*
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Day
Please select a month
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Month
Please select a year
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Year
First line of address
*
Postcode
*
Parent/Carer Name
*
First Name
Last Name
Parent/Carer email address
example@example.com
Parent/Carer mobile number – test result will be texted to this number
*
I understand this means my child will be supervised to conduct their own test
*
My child has previously tested positive for COVID 19
*
If yes, date tested positive (if known)
I have considered the information provided by Stormont House School about my child testing for COVID-19 and any questions have been answered satisfactorily.
I have discussed the testing with my child who is happy to participate. I understand that, if on the day of testing they do not wish to take part, they will not be made to and that consent can be withdrawn at any time ahead of the test.
I consent to my child taking Lateral Flow Tests as recommended by the government.
I consent to my child’s sample(s) being tested for the presence of COVID-19.
I understand that if a LFT test result is negative my child can continue to attend school and that I will only be contacted by Stormont House School if my child tests positive.
I understand that if my child’s LFT test indicates the presence of COVID-19 I will be informed and that they must then complete a home PCR test which I must send to NHS Test and Trace the same day. I understand that my child must self-isolate until I receive the results of the PCR test.
I understand that if my child’s PCR test result is positive, I must report this to Stormont House School and ensure my child self-isolates according to public health advice.
Parent/Carer Signature
*
Relationship to child
*
Date
*
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