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* 1. Name of person completing this form (parent/carer)

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* 2. Student First Name

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* 3. Student Surname

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* 4. What is the date of birth of the student?

Date

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* 5. Student Year Group 

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* 6. Student Gender

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* 7. Student Ethnicity

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* 8. What is the first line of the students address?

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* 9. Home Postcode

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* 10. Email Address
This is where test results will be sent.

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* 11. Mobile Phone Number.
This is where test results will be sent.  Please do not enter a landline number, test results can only be received by a mobile number.

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* 12. Please confirm that you are the parent or legal guardian of the child.

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* 13. Please give details of any health or accessibility issues which might affect your child's safe participation in the testing.  Please leave blank if not applicable.

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* 14. Please read the terms of consent and select the appropriate option:

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 [DD/MM/YYYY] 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 If on the day of testing they do not wish to take part, then they will not be made to do so and consent can be withdrawn at any time ahead of the test.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. In the case of under 16s or pupils 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 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 consent to having / my child having a nose and throat swab for confirmatory PCR testing. I/they will follow the instructions on the PCR Kit to return the test the same day to an NHS Test & Trace laboratory.

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 this PCR 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.

11. I consent that if a close contact of my child tests positive but I / my child has tested negative, I / they will continue to attend school / college but will be tested every day at school / college for 7 days.

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