Wilson Central School District Micro Cluster Testing Consent:  Students/Families
Wilson CSD

Given Niagara County's potential designation as a "Yellow Zone," the Wilson School District needs to prepare to engage in COVID testing required to keep our schools open.

We would be able to maintain our current instructional model in a yellow zone if we can conduct enough testing to meet re-opening requirements, otherwise, we would need to switch to fully remote for the duration of the micro-cluster designation. In a yellow zone, we would need to test and receive the results for 20% of in-person students and staff within a two-week period immediately following the announcement of our "yellow zone" designation. The students/staff are chosen at random until the designation is removed.

If the results of the testing revealed that the positivity rate among the 20% of those tested is lower than the yellow zone’s current 7-day positivity rate, testing at that school will no longer be required to continue and the school can remain open.

If the area's designation moves to an orange zone, we would need to test 20% of students and staff over a month's period of time. If we become a red zone, we would need to test 30% of students and staff over a month's period of time.

This notice of consent is being sent to all Wilson families, and please know the responses are kept confidential. We need to gauge the school community's consent to participate in this testing program as we continue our planning. The District is in the process of approval by the NYSDOH as a Limited Service Laboratory and is authorized to perform COVID-19 antigen testing. You can view a short video below showing how the sample for the BINEXNow test would be collected.

I think you will find it to be less invasive than other commonly used tests. I would respectfully ask you to consider giving consent for testing to help keep our schools stay open. Please submit the form by the end of the day Monday, January 4, 2021.

INFORMED CONSENT FOR COVID-19 TESTING
 
Please carefully read the following informed consent:

I understand that the Wilson Central School District requires a signed consent for Covid-19 testing of my Child. I understand I need to sign a consent before my Child under the age of 18 can be tested. I understand that typically active consent requires me to be present at the testing center and sign this consent in the collector's presence, however, I authorize Wilson Central School District, (anticipated to be an independent laboratory), to conduct collection and testing for Covid-19 through a nasal swab ordered by an authorized medical provider or public health official of my child and to do so without my being present at the testing. I understand that this testing is voluntary and that (I am not required) my child is not required, nor am I required, to authorize my Child to undergo such testing as a condition to attend school.  

I authorize my Child's test results to be disclosed to Wilson Central School District, my Child's health care provider, and any applicable county, state, or other governmental entity as required by law and understand that such disclosure will also be made consistent with applicable law.  

I acknowledge that a positive test result indicates that my child and I and members of our family (I) must abide by Wilson Central School District's isolation and quarantine policies and all applicable federal, state, and/or local guidance on isolation and quarantine to avoid infecting others.

By signing this document and agreeing and authorizing my Child to undergo Covid-19 testing, I understand that I am not creating a patient relationship for my Child or for me with the school district.  I understand that the Wilson Central School District is not acting as my Child's medical provider.  Testing does not replace treatment by my Child's medical provider.  I assume complete and full responsibility to take appropriate action with regards to my Child's test results.  I agree I will seek medical advice, care, and treatment from my Child's medical provider if I have questions or concerns or if my Child's condition worsens.

As with any medical test, I understand that there is the potential for false positive or false negative test results to occur. I understand that I will also need a letter from my Child's health care provider for my Child to return to school if my Child is being tested because he/she (work if I am being tested because I have) has symptoms of COVID-19 as determined by the District as an Independent Laboratory.

Thank you for your cooperation.

*Required
Sign in to Google to save your progress. Learn more
Email *
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of Wilson Central School District. Report Abuse