Student Consent Form for Optional COVID-19 Testing

The below form is to be completed by a parent/guardian of a student under 18 years old, or by a student who is 18 years old or older.

NYOS Charter School 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 on a campus, we are adding a voluntary K-12 COVID-19 testing program for students. This program uses Abbott Laboratories BinaxNOW tests 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, 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 BinaxNOW rapid test for the COVID-19 virus . Collecting a 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 and email 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 schools as healthy & safe as possible. The tests are being offered in addition to existing safety protocols such as mask-wearing, social distancing, and frequent disinfection of surfaces.

What should I do when I receive my child’s test results?

If your child tests 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 appear) and your child is no longer contagious. If your child’s test results 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 tests 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.

Known Symptoms:

People with COVID-19 have had a wide range of symptoms reported – ranging from 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 or smell
  • Cough
  • Difficulty breathing
  • Shortness of breath
  • Fatigue
  • Headache
  • Chills
  • Sore Throat
  • Conjestion 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 nor NYOS Charter School, nor any of its school board members, officers, employees, or organization sponsors are liable for any accident or injuries that may occur to your child as a result of agreeing to the test.

You will be notified with test results either via cell phone or email or both.

By signing below, I attest that:

  1. I authorize the school system to conduct collection and testing of the student identified below for COVID-19 by nasal swab.
  2. I acknowledge that a positive test result is an indication that the student must self-isolate and also continue wearing a mask or face covering as directed in an effort to avoid infecting others.
  3. 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 questions or concerns, or if their condition worsens.
  4. 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 risks, 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.
Subject
Parent/Guardian Full Name: (Required)
Parent/Guardian Cell/Mobile Number: (Required)
Parent/Guardian Email Address: (Required)
Child/Student Full Name: (Required)
Drivers License Number (if applicable):
Home Address (Required)
Student Grade Level: (Required)
Student Date of Birth: (Required)
Student Age: (Required)
Student Ethnicity: (Required)
Gender: (Required)
I, the undersigned, have been informed about the test purpose, procedures, possible benefits and risks, 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. (Required)
Parent/Guardian Signature: (Required)
Student Signature (if applicable):
Today's Date: (Required)
Email (Optional)
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