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

By digitally signing below, I attest that: ● I have signed this form freely and voluntarily, and I am legally authorized to make decisions for the child named above. ● I authorize the Naples Central School District to test my child for COVID-19 infection. ● I understand that my child may be tested at multiple times 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 other information 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 he/she meets the criteria to return to school according to the County Department of Public Health. ● I understand that this testing 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 his/her medical provider if I have questions or concerns or if they become ill or their condition worsens. ● I understand that, as with any medical test, there is the potential for a false positive or false negative COVID-19 test result.