COVID-19 Testing Consent Form
Valley Heights is getting FREE Rapid Response test kits through Clinical Reference Laboratory (CRL) . This is a saliva-based COVID-19 RT-PCR test. The test, shown in CRL's EUA (Emergency Use Authorization), studies to be more sensitive and accurate than the standard COVID-19 anterior nasal swab test, detects the presence of coronavirus in the saliva of the test taker. This test can be done with or without symptoms of COVID-19. This is not an antibody test that looks for whether you have had COVID-19 in the past.

Please have your student bring their cell phone or school provided iPad, they will need it to activate their test kit (the devise has to have a camera on it). Once they activate their kit they will be able to view their results when they are reported. The student will enter their information along with Parent/Guardian contact information if they are under the age of 18. The test will only consist of your students fresh saliva in a tube.
***Do not allow your student to eat, chew, or drink anything (even water) for at least 30 minutes prior to the test.***
Results are usually received within 24-48 hours. Test results will be sent to the Marshall County Health Department and they will provide the results to our School Nurse.

***If your student has previously tested positive for COVID-19, we do not want to test them at this time.***

***Once your child gets this test administered, they DO NOT need to quarantine UNLESS showing symptoms.***

We need you as Parent/Guardian to complete this consent form.

Please reach out to Jenna Vathauer, if you have any questions.
jvathauer@valleyheights.org ~ 785-363-2508c
Sign in to Google to save your progress. Learn more
Student's First & Last Name *
I give Valley Heights permission to give my student the COVID-19 saliva test. *
Required
Name of Parent/Guardian completing consent form. *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Valley Heights School District 498. Report Abuse