BINAX Testing Waiver
USD 252 - Consent to COVID-19 Test

Please carefully read and provide acknowledgment of the following informed consent:

a. I authorize a COVID-19 testing administrator associated with the school district, local health department or state health department to conduct collection and testing for COVID-19 through a saliva sample, nasal or nasopharyngeal swab collection as ordered by an authorized medical provider or public health official.

b. I authorize my test result, or the test result of my child if my child is under the age of 18 years, to be disclosed to the county, state, or to any other governmental entity as may be required by law.

c. I understand that, as with any medical test, there is the potential for a false positive or false negative COVID-19 test result.

d. I give permission for the Lyon County Health Department and my school district to contact me using non-secure methods (e-mail and phone calls) regarding this COVID-19 test result, and I understand the risks involved.

e. I acknowledge that a positive test result is notice that I must self-isolate, avoid others and/or remain in my home in compliance with the health department.

f. I understand that if I receive a positive test and wish to proceed with a PCR molecular test for confirmatory positive testing, I must be tested within 48 hours. Otherwise, the positive test result from Binax will be considered final.

g. Please remember, that if you are in quarantine due to a COVID exposure, a negative test does not shorten the length of quarantine.
Sign in to Google to save your progress. Learn more
Waiver consent *
Clear form
Never submit passwords through Google Forms.
This form was created inside of USD 252 Southern Lyon County. Report Abuse