COVID-19 Rapid Test Parent/Guardian Consent Form

COVID-19 Rapid Test Parent/Guardian Consent Form

School Year 2022-2023
Oxford Hills School District seeks to maintain a safe environment for employees, students, their families, and the community. This consent form provides MSAD17 or its designee with your permission to perform a COVID-19 screening test for your child at the school or its designated site.

By signing below, you are indicating that you voluntarily consent to this screening procedure for the detection of COVID-19 for your child. Please read the attached information accompanying this form regarding school-based testing.

COVID-19 Test Information Statement

For Rapid BinaxNOW Ag Testing:

The test may be collected by self-swab or by a school designee. The test involves a nasal swab that is used to determine the potential presence of COVID-19. The specimen collected for a rapid test will have results in approximately 15-20 minutes. The school will share the results with the CDC for public health reporting. The school or its designee will communicate those results to you following the test. Additionally, the school or its designee will provide instructions on any appropriate next steps.
Section 1:

Information about your child:
Students Name*

First NameLast Name
Student's Birth Date*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Legal Guardian's Name*

First NameLast Name
Parent/Guardian's Daytime Phone Number*
Please enter a valid phone number.
School Name*
Grade*
Section 2:

Consent:
CONSENT FOR CHILD’S COVID-19 TEST:

I have read or had explained to me the COVID-19 Testing Information Statement, above, and have had the opportunity to seek answers to my questions about the risks and benefits of this test.
I, First Name Last Name, CONSENT to my child receiving a Rapid BinaxNOW Ag COVID-19 Test administered by Oxford Hills Comprehensive High School or it's designee in a school setting if my child becomes symptomatic during the school day or if the school is offering screening tests for COVID-19. (If this consent form is not signed, then your child will not receive the test.)
Signature*

Clear
Should be Empty:

COVID-19 Rapid Test Parent/Guardian Consent Form

Section 1:

Section 2: