Shelley College Student Consent Form for COVID-19 Testing (March 2021)

Dear Parent/Student

Please ensure you have read Form A - Consent form for COVID-19 testing in secondary schools (including sixth form) prior to completing this form.

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* 1. Student's full name

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* 2. Year group/form

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* 3. Date of birth (DD/MM/YYYY)

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* 4. Email address for test results to be received

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* 5. Mobile number for test results to be received. Please note results cannot be sent to a landline number

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* 6. Name of parent/guardian giving consent

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* 7. Relationship to student

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* 8. Date (DD/MM/YYYY)

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* 9. Details of any health or accessibility issues which might affect a student's safe participation in the testing exercise

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* 10. I confirm that I have read the terms of consent in Form A - Consent form for COVID-19 testing in secondary schools (including sixth form)

Yes

No

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* 11. I/my child gives consent to having the first 3 lateral flow tests on the school site in line with the terms of consent in Form A

Yes

No

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* 12. Thereafter, I/my child gives consent to having 2 lateral flow tests per week at home until further notice in line with the terms of consent in Form A

Yes

No