Northshore School District COVID-19 Screening Testing Information and Opt-Out Form

This school year, Northshore School District will batch test students in each classroom and provide follow-up confirmatory testing to anyone in a positive batch. Participation in the Northshore School District testing program is voluntary as parents and guardians may decide to opt-out of screening testing for their child, and any students who have reached the age of 18 can opt-out on their own behalf.

Managing COVID-19 to help reduce transmission and keep adolescents, families and communities healthy and safe requires a coordinated response. The Centers for Disease Control and Prevention (CDC) and the WA Department of Health (DOH) both recommend COVID-19 screening testing as a mitigation strategy for reducing the risk of COVID-19 infections.

This form will be used to share information about the COVID-19 screening testing program only. Other types of testing are mandatory. For example, if your child is symptomatic for COVID-19, he or she must be tested for COVID-19. In addition, the Washington State Department of Health has mandated screening testing for certain athletics and extracurriculars. This form cannot be utilized to opt-out of those testing programs for school-based testing compliance purposes.

What is a COVID-19 Test? 

• A shallow nasal swab sample collection that is self-collected under the observation of a district staff member and/or supervised or collected by an approved labor partner determined by the Department of Health.

What is screening testing? 

There are various types of screening testing, which are described below. 

• Asymptomatic pooled testing: Routine testing of individuals without symptoms or any history of exposure. Samples are processed in “pools”. This is also referred to as batch testing. If the pool tests positive, there is follow-up testing (reflex testing) for each individual in the pool.
• Close contact testing: As-needed testing for individuals identified to be a close contact of someone who was diagnosed with COVID-19 or is suspected of having COVID-19.
• Reflex testing: Individual testing for each person who had submitted a sample for a pool test that came back positive (meaning the pool was positive).

How frequently will testing be done?

• Pooled/batch testing will be once a week. 
• Close contact testing will be done as needed to identify potential infection in close contacts of individuals diagnosed with COVID-19 or suspected of having COVID-19
• Reflex testing will be done for all individuals who submit a sample to a pool test which returns a positive result for the pool.

Please carefully read the following consent notice regarding COVID-19 testing. Unless you affirmatively opt out of testing by taking the steps described below, we will record you as having consented to your child receiving COVID-19 testing and to have understood the disclosures set forth below.

1. You or your child will be automatically enrolled for routine COVID-19 testing as provided by Northshore School District for the 2021-2022 school year.
2. I understand that the ability for my child (or I) to receive testing is limited to the availability of test supplies.
3. I understand the entity performing the test is not acting as my or my child’s medical provider. Testing does not replace treatment by a medical provider. I assume complete and full responsibility to take appropriate action with regards to the test results, including seeking medical advice, care, and treatment from a medical provider or other health care entity.
4. I understand that, as with any medical test, there is the potential for a false positive or false negative COVID-19 test result.
5. I understand it is my responsibility to inform my or my child’s health care provider of a positive test result, and that a copy of my or my child’s test result will not be sent to my or my child’s health care provider.
6. I understand and acknowledge that a positive test result is an indication that my child (or I) should self-isolate to avoid infecting others.
7. I have been informed of the test purpose, procedures, and potential risks and benefits. I will have the opportunity to ask questions of school officials before proceeding with a COVID-19 test.
8. I understand that to ensure public health and safety and to control the spread of COVID-19, the test results may be shared without my individual authorization.
9. I understand that the test results will be disclosed to the appropriate public health authorities, the Office of Superintendent of Public Instruction, and as otherwise permitted or required by law.
10. I understand that if I do not wish for my child (or I) to participate in COVID-19 testing, I must opt-out of the program by filling out the opt-out form below and returning it to the program contact as described below, which I am free to do at any time. 

( DO NOT complete unless you wish to opt-out of testing)

By signing below, I attest that:

• I have read and understood the information provided in the Northshore School District COVID-19 Testing Program handout and do not wish to participate (or for my child to participate) in the COVID-19 testing program for the 2021-2022 school year. 

• I understand I may change my decision at any time and elect to participate in the program by submitting a written letter to the program contact indicating that I would like my child (or I) to receive COVID-19 testing.