BinaxNOW Rapid COVID-19 Testing Consent
The Whitewright Independent School District takes the health and safety of our students and their families very seriously. As such, in addition to steps to screen for the virus and prevent its spread on a campus, we are adding a voluntary K-12 COVID-19 testing program for symptomatic staff and students. This program uses Abbott Laboratories BinaxNOW tests provided by the federal government. We will only test with your consent. If you are willing to provide consent for us to administer this test on your child or yourself (if student age 18 or older), please fill out this form.
Parent/Guardian Name *
Parent/Guardian Email *
Parent/Guardian Mobile Phone # (results will be sent via text to this number) *
Student First/Last Name
Street Address, City, State, Zip Code
School
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Student Date of Birth
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Student Age
Gender
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By signing below, I attest that: I authorize the school system to conduct collection and testing of my child or me (if student age 18 or older) for COVID-19 by nasal swab. I acknowledge that a positive test result is an indication that my child or me (if student age 18 or older), must self-isolate and also continue wearing a mask or face covering as directed in an effort to avoid infecting others. I understand the school system is not acting as my child’s medical provider, this testing does not replace treatment by my child‘s medical provider, and 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 their condition worsens. I understand that, as with any medical test, there is the potential for a false positive or false negative COVID-19 test result. I, the undersigned, have been informed about the test purpose, procedures, possible benefits and risks, and I have received a copy of this Informed Consent. I have been given the opportunity to ask questions before I sign, and I have been told that I can ask additional questions at any time. I voluntarily agree to this testing for COVID-19. Please type your full name in the space below. Your typed name serves as your electronic signature of consent. *
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