Consent Form for COVID-19 Testing in Secondary Schools and Colleges - Outwood Academy Adwick
This consent form is for participation in tests designed to detect asymptomatic coronavirus cases. Anyone experiencing symptoms should follow government guidelines to self-isolate, even if they have had a recent negative lateral flow test.
Consent relates to the following groups of students/pupils and staff as follows:
- For pupils and students younger than 16 years - this form must be completed by the parent or legal guardian. Please complete one consent form for each child you wish to participate in testing.
- Pupils and students over 16 who are able to provide informed consent - can complete this form themselves, having discussed participation with their parent / guardian if under 18.
- For any pupil or student who does not have the capacity to provide informed consent - this form must be completed by the parent or legal guardian. Please complete one consent form for each child you wish to participate in testing.
- Staff will complete this form themselves.
Terms of consent
1. I have had the opportunity to consider the information provided by the school/college about the testing, ask questions and have had these answered satisfactorily, based on the information presented in the letter dated 31/12/2020 and the attached Privacy Notice.
2. In the case of under 16s, I have discussed the testing with my child and my child is happy to participate. If on the day of testing they do not wish to take part, then they will not be made to do so and consent can be withdrawn at any time ahead of the test.
3. I consent to having / my child having a nose and throat swab for lateral flow tests. I / my child will self-swab if I / my child is able to otherwise I understand that assistance is available.
4. I understand that there may be multiple tests required and this consent covers all tests for the below named person. If, on the day of testing I / they do not wish to take part, then I understand I / they will not be made to do so and that consent can be withdrawn at any time ahead of the test.
5. I consent that my / my child’s sample(s) will be tested for the presence of COVID-19.
6. I understand that if my /my child’s result(s) are negative on the lateral flow test I will not be contacted by the school/college except where I am / they are a close contact of a confirmed positive.
7. If the lateral flow test indicates the presence of COVID-19, I commit to ensuring that I / my child is removed from school premises as promptly as possible, bearing in mind I / they may have some anxiety following a positive test result.
8. I understand that I / they will need to self-isolate following a positive lateral flow test result.
9. I agree that if my / my child’s test results are confirmed to be positive from this lateral flow test, I will report this to the school / college and I understand that I/ my child will be required to self-isolate following public health advice.
10. I understand that if a close contact of my child tests positive that my child will self-isolate for 10 days in line with Government guidance.
Student's First Name
Date of Birth
Another Asian background
Asian or Asian British
Another Black background
Black, African, Black British or Caribbean
Asian and White
Black African and White
Asian and white
Black African and white
Black Caribbean and white
Another mixed background
Mixed or multiple ethnic groups
British, English, Northern Irish, Scottish or Welsh
Irish Traveller or Gypsy
Another white background
Another ethnic background
Another ethnic group
First line of Address
Contact Email Address (This is where the test results will be sent)
Contact Mobile Phone Number (This is where test results will be sent. Please do not put a landline number – you can only receive test results to a mobile number.)
Consent Given By (Name)
Relationship to Test Subject
Details of any health or accessibility issues which might affect a child's safe participation in the testing exercise.
Currently showing any COVID-19 symptoms?
Signature (Typing out your name is sufficient if you are filling out this form digitally)
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This form was created inside of Outwood.