New Intake: Lateral Flow Testing - Consent
Please complete the following form to indicate whether or not you would like your child to participate in the two Lateral Flow Tests outlined by the Department for Education.
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Your Child's First Name
Your Child's Surname
Your Child's Tutor Group (e.g. 7A1)
I give consent for my child to participate in the Lateral Flow Testing initiative outlined by the Government and the Department for Education.
No (If you have selected this option, please proceed to Question 11 - asking for your name)
Your Child's Gender - this information is needed for the Department of Health and Social Care research purposes.
Your Child's Ethnicity - this information is needed for the Department of Health and Social Care research purposes.
Asian or Asian British
Black, African, Black British, Carribean
Mixed or multiple ethnic groups
Prefer not to say
Is your child currently showing any Covid-19 symptoms?
Mobile Number - this is where test results will be sent. Please do not give a landline number - you can only receive results to a mobile device.
Name of Parent/Carer giving consent
Relationship to the Child
Signature - typing out your name is sufficient
Please add details of any health or accessibility issues which might affect a child's safe participation in the testing exercise.
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This form was created inside of Q3 Academy Langley.