By completing and submitting this form, I confirm that I am the appropriate parent / legal guardian to provide consent, and that I authorize the collection of specimens necessary to conduct COVID-19 testing on my student during school hours or in connection with school attendance/ a school activity. I understand that authorizing COVID-19 testing for my student is optional and that I can refuse to give this authorization, in which case, my student will not be tested. COVID-19 screening testing will be conducted using a pooled PCR testing method. Screening testing will be conducted by a contracted vendor or school personnel. Any needed confirmatory or “follow-up” testing will be conducted by either a contracted vendor or school personnel. Diagnostic testing (including testing of close contacts), may be conducted using BinaxNOW antigen tests proctored through a brief telehealth visit with a contracted vendor, in addition to utilizing PCR testing.
West Windsor-Plainsboro RSD and testing provider, Mirimus Inc., will maintain a copy of this consent form according to existing state and federal records retention laws and will only provide COVID-19 Testing to students who have a completed consent form on file.
I understand that I can change my mind and cancel this permission at any time. To cancel this permission for COVID-19 testing, I need to contact [POC Name] directly at [Contact Info].