Informed Consent for Student Rapid Antigen Test

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SMUSD offers rapid antigen testing to students that develop symptoms during the school day or in response to close contact exposure. Prior to any COVID testing of minors, informed consent from the minor's parent or guardian is required. This consent is NOT for the weekly PCR test administered by OmniPathology/PRIVIT. This consent is for rapid antigen testing by SMUSD staff.

We now offer parents or guardians the ability to provide consent ahead of time to expedite the testing process. Please review the Consent below. If you wish to consent to SMUSD performing a rapid antigen nasal swab test due to symptoms that develop at school or in response to a close contact exposure for your student, please complete this form and select "I provide consent..." ONE RESPONSE PER STUDENT.

If you do not agree to provide consent at this time or wish to withdraw consent, please complete this form and select "I do not provide consent."

School Site

Carver Elementary School

Valentine Elementary School

Huntington Middle School

San Marino High School

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Grade

Student First Name *

Student Last Name *

Student Date of Birth *

YYYY

SMUSD Student ID Number

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Name of Parent or Guardian Completing this Form *

Informed Consent *

I provide consent through June 30, 2022

I do NOT provide consent.

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