K-12 COVID-19 Testing Consent Form
By completing this form, I confirm that I am the parent or guardian of the student(s) listed above, and that I consent to allow for my student to be tested for COVID-19 during the 2021-2022 academic school year by providing either a shallow nasal swab or a saliva sample.
I understand that COVID-19 testing for the student(s) is optional and that I may refuse to give consent. I understand that my student(s) must stay home from school if feeling unwell.
I understand that an independent laboratory acting on behalf of my school will conduct the weekly screening testing. I understand that in order for weekly screening testing to be performed at an independent laboratory, I must register my student at www.LabDash.net to participate in this testing program (assistance for registering in LabDash is available by calling 541-368-3050 or by e-mailing covid@wvtlab.com).
I understand that the school is not acting as my student’s healthcare provider, this testing does not replace treatment by my student‘s healthcare provider, and I assume complete and full responsibility to take appropriate action regarding the student’s test results. I understand that it remains my responsibility to seek medical advice, care and treatment for my student(s) from their healthcare provider.
I understand that if my student(s) tests positive for COVID-19, the test result will be reported to the local public health authority as required by law. However, personal health information will not be released without written consent except when required by law.

You can get this document in other languages, large print, braille, or a format you prefer. Contact the Coronavirus Response and Recovery Unit (CRRU) at 503-979-3377 or email CRRU@dhsoha.state.or.us. We accept all relay calls or you can dial 711.
This project is supported by the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award to the State of Oregon. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HHS, or the U.S. Government.

For more information on the Ready Schools, Safe Learners Program and more, visit: https://www.oregon.gov/ode/readyschools/Pages/default.aspx.
Sign in to Google to save your progress. Learn more
We currently have this online form available in English & Spanish. Please select which language you would like to continue in, or see above if you need this consent form in an alternative format or language. *
Clear form
Never submit passwords through Google Forms.
This form was created inside of Willamette Valley Toxicology. Report Abuse