Student Consent Form For Optional COVID-19 Testing
The New Summerfield ISD 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 in our schools, we are adding a voluntary K-12 COVID-19 testing program for students.  This program uses GenBody test 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 our child or yourself (if student age is 18 or older), please fill out this form.  

What is the test?  
If your child is symptomatic or part of a group that is designated for testing, if you consent, your child will receive a free GenBody rapid test for the COVID-19 virus.  Collecting the specimen for testing involves using a swab, similar to a Q-tip, placed inside the tip of the nose.  A school staff member who has been trained to use this test will collect the specimen and a trained COVID-19 test administrator will oversee the process.  Test results will be made available to the parent / guardian who signs this form below.  The results will be sent by text message, email or phone call within 24 hours of the test.  This program is entirely optional for students, although we hope you choose to have the test to keep our school as healthy and safe as possible.  The test are being offered in addition to existing safety protocols such as optional mask wearing, social distancing when possible and frequent disinfection of surfaces.

What should I do when I receive my child's test results?
If your child or you (if student is 18 years or older) test positive for the virus, your child will be moved to a room away from other students and staff until you can pick him/her up.  We ask that you keep your child home until the infection period has ended (typically, after symptoms improve and at least 10 days from the date symptoms first appeared) and your child is no longer contagious.  If your child's test are negative, the virus was not found in the specimen tested and your child may continue to attend school without interruption.  In a small number of cases, tests sometimes produce incorrect results - showing negative results (called "false negatives") in people who have COVID-19 or showing positive results (called "false positives") in people who don't have COVID-19.  If your child test negative but has symptoms of COVID-19, or if you have concerns about your child's exposure to COVID-19, you should call your child's doctor, a licensed medical authority, or your local health department.  

Know Symptoms:
People with COVID-19 have had a wide range of symptoms reported - ranging form mild symptoms to severe illness.  Symptoms may appear 2-14 days after exposure to the virus.  People with these symptoms may have COVID-19:

  * Feeling feverish or a measured temperature greater than or equal to 100.0 degrees Fahrenheit.
  * Loss of taste and / or smell.
  * Cough.
  * Difficulty breathing.
  * Shortness of breath.
  * Fatigue.
  * Headache.
  * Chills.
  * Sore Throat.
  * Congestion or runny nose.
  * Shaking or exaggerated shivering.
  * Significant muscle pain or ache.
  * Diarrhea.
  * Nausea or vomiting

This list does not include all possible symptoms.

Disclaimer:
While we realize precautions will be taken for the safety of students, please understand that neither the test administrator not the New Summerfield ISD, nor any of its trustees, officers, employees, or organization sponsors are liable for any accident or injuries that may occur to your child or yourself (if student is 18 or older), as a result of agreeing to the test.

TO BE COMPLETED BY PARENT, GUARDIAN OR ADULT STUDENT
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PARENT / GUARDIAN PRINT NAME:
PARENT / GUARDIAN CELL OR MOBILE NUMBER:
PARENT / GUARDIAN EMAIL ADDRESS:
CHILD / STUDENT NAME:
CHILD / STUDENT  SCHOOL ID NUMBER
CHILD / STUDENT DRIVER'S LICENSE NUMBER (if applicable)
CHILD / STUDENT STREET ADDRESS
CHILD / STUDENT CITY,  STATE AND ZIP CODE
CHILD / STUDENT CAMPUS
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CHILD / STUDENT DATE OF BIRTH
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CHILD / STUDENT ETHNICITY
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CHILD / STUDENT GENDER
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CONSENT
A.  I authorize the school system to conduct collection and testing of my child or me (if student is 18 years or older) for COVID-19 by nasal swab.

B.  I acknowledge that a positive test result is an indication that my child or me (if student is 18 years or older) must self-isolate and also continue wearing a mask or face covering as directed in an effort to avoid infecting others.

C.  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 any questions or concerns, or if their condition worsens.

D.  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 risk, 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.  
SIGNATURE OF PARENT / GUARDIAN (PLEASE TYPE NAME TO GIVE CONSENT).
SIGNATURE OF STUDENT (IF AGE 18 OR OVER) OR OTHERWISE AUTHORIZED TO CONSENT.
DATE OF WHEN THE FORM WAS SIGNED.
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