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* 1. Forename

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* 2. Surname

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* 3. Form

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* 4. Date of Birth

Date

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* 5. Gender - this information is needed for Department for Health and Social Care research purposes.

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* 6. Ethnicity - this information is needed for Department for Health and Social Care research purposes

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* 7. Currently showing any COVID-19 symptoms?

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* 8. Home Postcode

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* 9. Email Address – this is where test results will be sent        

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* 10. 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.

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* 11. Name of Parent/Carer giving consent

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* 12. Relationship to test subject

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* 13. Signature (typing out your name is sufficient if you are filling in this form digitally)

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* 14. Today’s date

Date

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* 15. Details of any health or accessibility issues which might affect a child’s safe participation in the testing exercise.

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* 16. 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 and staff 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.

•       Staff will complete this form themselves.

TERMS OF CONSENT please tick all that apply -

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