COVID Consent Form

NativityMiguel Middle School Parent Consent for COVID-19 Screening

NativityMiguel Middle School Parent Consent for COVID-19 Screening

As required by New York State, NativityMiguel Middle School will begin the process of screening faculty, staff, and students for COVID-19 infection in order to return to in-person learning.  With your consent, your child will receive a free diagnostic screening for the COVID-19 virus that will be administered by a trained professional on school grounds.

NativityMiguel will use the Abbott BinaxNOW COVID-19 Ag Card screening tool, which will involve inserting a small swab, similar to a Q-Tip, into the front of the nose.  While reliable as a screening tool, these tests do not deliver 100% accurate results, and students who test positive will require follow-up testing using a more accurate instrument. We will notify you if your child tests positive for COVID-19, and your child will be sent home and referred to a local testing center and/or your primary care physician. Students who are positive for COVID-19 must follow all Erie County Department of Health criteria to return to school.

The law requires and/or allows some information about your child to be shared with Erie County and New York State Public Health Agencies.  This includes notifying the Erie County Department of Health about the COVID-19 results of each student who is tested and may include the student’s name, date of birth, race, ethnicity, gender, address, phone number, and result of the COVID-19 test.

By completing the form below, I attest that:

  • I have signed this form freely and voluntarily, and I am legally authorized to make decisions for the child named below.
  • I authorize NativityMiguel Middle School to test my child for COVID-19 infection.
  • I understand that my child may be tested more than once during the 2020-2021 school year.
  • I understand that this consent form will be valid through June 30, 2021, unless I revoke such consent in writing.
  • I authorize my child’s test results and the other information listed above to be disclosed to any governmental entity as may be required or permitted by law.
  • I acknowledge that a positive test result will require my child to be sent home from school and remain at home until the child meets the criteria to return to school according to the Erie County Health Department.  A student who tests positive will be referred to the Erie County Department of Health or New York State Department of Health for further testing.
  • I understand that this screening does not replace treatment by my child’s medical provider, and I assume complete and full responsibility to take appropriate action regarding my child’s test results.  I agree that I will seek medical advice, care, and treatment for my child from my child’s medical provider and that I will contact the medical provider if I have questions or concerns.
  • I understand that, as with any medical test, there is the potential for a false positive or false negative COVID-19 test result.

Parent Consent for COVID-19 Screening

  • I understand and acknowledge that by writing or typing my name below, I am confirming that I have read this entire form and that the information I have provided is true and accurate. I intend for this to serve as my electronic signature and I am authorizing NativityMiguel Middle School to rely on my electronic signature. I understand and acknowledge that this electronic signature has the same legally binding effect as if I had placed my handwritten signature on a paper form.