Landau Forte Charitable Trust
Consent form for COVID-19 testing
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 as follows:
For 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.
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 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.
Terms of consent
1. I have had the opportunity to consider the information provided by the school about the testing, ask questions and have had these answered satisfactorily, based on the information presented and 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 If on the day of testing they do not wish to take part, then they will not be made to do so and consent can be withdrawn at any time ahead of the test.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 swab for lateral flow tests. I / my child will self-swab. In the case of under 16s or students who are not able to provide informed consent, I have discussed the testing with my child and they are happy to participate and self-swab (with assistance if required).
4. I understand that there may be multiple tests required during academic year 2020/21 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testing I / they do not wish to take part, then I understand I / they will not be made to do so and that consent can be withdrawn at any time ahead of the test.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.
7. If the lateral flow test indicates the presence of COVID-19, I consent to having / my child having a nose and throat swab for confirmatory PCR testing.
8. 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.
9. I consent that I / they will need to self-isolate following a positive lateral flow test result, until the results of the confirmatory PCR have been received.
10. I agree that if my / my child’s test results are confirmed to be positive from a PCR test, I will report this to the school and I understand that I/ my child will be required to self-isolate following public health advice.
Name
*
First
Last
Date of birth
*
DD
/
MM
/
YYYY
Year Group (If applicable)
*
Please Select
7
8
9
10
11
12
13
Staff
Gender – this information is needed for Department for Health and Social Care research purposes.
*
Male
Female
Ethnicity - this information is needed for Department for Health and Social Care research purposes
*
Asian or Asian British
Black, African, Black British or Caribbean
Mixed or multiple ethnic groups
White
Prefer not to say
Currently showing any COVID-19 symptoms?
*
Yes
No
Home Postcode
*
First line of address
*
Email Address - this is where test results will be sent
*
Mobile 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.
*
Name of parent/guardian giving consent
*
Relationship to test subject
*
Signature (typing out your name is sufficient if you are filling in this form digitally)
*
Today's Date
*
MM
/
DD
/
YYYY
Details of any health or accessibility issues which might affect a child’s safe participation in the testing exercise.
*
Do Not Fill This Out
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