Consent for school-based COVID-19 testing
The Glens Falls City School District is seeking your consent to test your child for COVID-19 infection using the Abbott ID Now and/or BinaxNOW COVID-19 Rapid Test.

The use of this rapid test would only occur if your child’s school is open for in-person instruction and falls within a state-designated Yellow Zone. Schools in a Yellow Zone are required to test 20% of in-person students, teachers, and staff members as required by state regulation. Once your child tests, they will not be tested again at school until all consented students have been tested.

If you consent, your child may be randomly selected to receive a free diagnostic test for the COVID-19 virus that will be administered by our Middle School and Sports Nurse, Tracy Webster, RN. The testing process will involve inserting a small swab, similar to a Q-Tip, into the front of the nose. This is the simple, quick, shallow nasal swab test. Results are available in 15 minutes.

The law allows some information about your child to be shared with and among certain Warren County and New York State agencies and their contract service providers, including Warren County Public Health, New York State Department of Health, and New York State Education Department. This information will only be shared for public health purposes, which may include notifying close contacts of your child if they have been exposed to COVID-19, and taking other steps to prevent the further spread of COVID-19 in our school community. Information about your child that may be shared with with these agencies include your child’s:

Name and COVID-19 test results
Date of birth/age
Gender and race/ethnicity
School name
Teacher name and classroom or cohort designation
Enrollment and attendance history
Names of siblings and guardians
Home address, telephone number(s), and parent/guardian email address

Testing is not mandatory, and nobody will be excluded from school because they choose not be tested. However, we are asking parents to consider that if we do not have consent to test a unique 20% of students and staff each week while in the Yellow Zone, we may need to move to fully remote learning. Please indicate your consent or non-consent below.

Your responses on this form will only be used to comply with NYS DOH reporting requirements.
Student First Name: (please use their name in Parent Portal, not a nickname) *
Student Last Name: *
Student Date of Birth: *
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/
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Student Gender: *
Student Race: *
Student Ethnicity: *
School this child attends: *
Grade level of this child: *
Home Street Address: *
City, State, Zip: *
Required
Parent/Guardian Phone Number *
Parent/Guardian email address: *
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