COVID-19 Testing Consent Form
Parents/Guardians - please fill out a form for each student in your household.
Please select the program your student attends
In-Person Grades K-6
Hybrid Grades 7-12
Student's Full Name
Parent/Guardian Full Name:
Relationship to Student
In order for the district to be in compliance with the NYSDOH Mandatory COVID-19 Testing in Public Schools Located in Areas Designated as “Yellow Zones” under the New York State Cluster Action Initiative, a percentage of the students and staff must be tested for the school district located in a designated yellow zone.
Yes, I agree: I give my consent for my child to be tested per the NYS Cluster Action Initiative. I understand this allows my child to be tested at NY Mills UFSD and personal submission of the test results given to the district.
No, I do not agree: I DO NOT give my consent for my child to be tested per the NYS Cluster Action Initiative.
If you selected 'yes', would you like to be present during your child's test?
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This form was created inside of Oneida-Herkimer-Madison BOCES.