PSD COVID Student Testing - Permission/Registration Form

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*Same day sign-ups are not guaranteed to be tested*
*You only need to submit form one time for each student, and they will be tested bi-weekly*
*If you no longer wish for your student to be tested, please call the school*

Dear Parents/Guardians:

The Rhode Island Department of Education (RIDE), in collaboration with the Rhode Island Department of Health (RIDOH), is pleased to announce that we are now offering participation in a COVID-19 testing program at Portsmouth Schools. Rhode Island continues to pursue aggressive testing for COVID-19 as a foundation for addressing the pandemic in the state. As part of the state testing approach, we are now testing in schools.

Portsmouth School Department is being provided a supply of variety of testing options. These tests have been made available to RIDOH from the federal government. All students, staff, and teachers at schools are being offered testing through this program until the end of the 2021/2022 school year free of charge. The district aims to offer an ongoing testing program to all students and staff, although future testing may be dependent on supplies.

Asymptomatic testing
Asymptomatic testing will be conducted according to RIDOH guidelines using a PCR test.
For each testing session, each student being tested will receive two nasal swabs that will be inserted into each nostril to obtain some mucus from the membranes of the nostril. This swab will be transferred to the Dominion Diagnostic Lab at the end of the day. Results of testing will be reported to schools and RIDOH. Positive results will be available on the state portal The results of this test will be available within 24-48 hours. You will be contacted if the result is positive. This consent will apply for all testing sessions going forward through the end of the 2021/2022 school year. At any time, you or your child may decline to participate.

Symptomatic testing
Symptomatic testing will be conducted at school on students presenting with symptoms of Covid 19 using a rapid BiNax Antigen test. Students with a positive BiNax will be sent home and quarantine according to RIDOH guidelines. If the BiNax is negative a follow up PCR will be done. Students who are symptomatic will be sent home from school until PCR results are reported.

Principals school nurses, and other school personnel may have access to the results of the testing. Your results may be reported to the Rhode Island Department of Health. If you have any additional questions about the program you may reach out to PSD by calling Linn Alvarnas Nursing Coordinator/Covid Coordinator (401) 849-3700 x3612.

In order for your student to participate in this testing program, your permission is needed. Please attest via a
digital signature if you would like your student to participate.

Email *

Student First Name *

Student Last Name *

Parent/Guardian Who Is Signing Full Name (Last, First) *

School *

Melville Elementary

Hathaway Elementary

Portsmouth Middle School

Portsmouth High School

Family Contact Phone/Cell Number *

Individual Being Tested Date of Birth *

YYYY

Individual Being Tested Zip Code *

Please Confirm Yourself as a Parent/Guardian *

Yes, I certify that I am a parent/guardian of this child.

Required

Areas of Understanding *

This requires a swab inserted into both nostrils to obtain a sample for COVID testing.

My child/student can opt-out at any time.

Required

Testing Options (select one or both options) *

I give full permission for my child/student to be tested at asymptomatic testing

I give full permission for my child/student to be tested at symptomatic testing

Required

Areas of Understanding - Please Use a Two-Character Initial *

I warrant the truthfulness of the information provided in this electronic form. The following is my two-character initial.

Digital Signature *

I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Areas of Understanding.

Required

Today's Date *

YYYY

A copy of your responses will be emailed to the address you provided.

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