By signing below, I consent to follow and understand that my child must follow School District of Philadelphia Health and Safety protocols, consent to my child’s being tested through the testing models checked off above, consent to test results being shared with me at the phone number and/or email address provided above, and also and agree to the following:

● I am signing this form freely and voluntarily and I am the parent or legal guardian of and am authorized to make decisions for the child named above.

● I understand that my student’s test results and related information will be forwarded securely to the Philadelphia Department of Public Health, the Pennsylvania Department of Health, and the Centers for Disease Control in accordance with communicable disease reporting.

● I understand that the School District of Philadelphia, school nurse, and/or testing partner are not acting as my child’s medical provider and that this testing does not replace treatment by my child's medical provider, and I assume complete and full responsibility to follow up with a medical provider to determine appropriate action with regard to my child’s test results.