Student Testing Covid Form
Student Consent: All students are required to provide consent for testing by December 7 or by their first scheduled in-person learning day. If a student arrives on their first day of in-person without a consent form in hand or submitted online, you must call their parent or guardian that day to collect consent immediately.

o Families can submit consent using NYCSA or this updated consent form. Please note that even if parents previously provided consent, we are asking them to submit again to ensure they have the updated consent form for their child that reflects the requirement for weekly testing in your school.

o Students who need a medical exemption or disability-based exemption (available for students with IEPs) will be able to submit separate forms for approval. (ADDITIONAL INFORMATION FORTHCOMING).

o Students without consent and who do not have medical exemption or disability-based exemption will be moved to fully remote instruction.

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Email *
Consent for COVID Testing
Parent/Guardian Information
Parent/Guardian Last Name: *
Parent/Guardian First Name: *
Parent/Guardian House Address: # and Street *
City *
State *
Zip Code *
Parent/Guardian Telephone/Mobile #: *
Best way to contact you: *
Child/Student Information
Child/Student Last Name: *
Child/Student First Name: *
Child/Student ID/OSIS Number:
Child/Student Birth Date: *
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Child/Student School *
Child/Student Address: House # and Street Name *
City *
State *
Zip Code *
Consent
I give consent for testing: Signature of Parent/Guardian *
Date *
MM
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DD
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YYYY
A copy of your responses will be emailed to the address you provided.
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