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LFD Testing
LFD Consent Form

LFD Consent Form

Testing is voluntary; however, we would encourage everyone to participate in the asymptomatic testing programme to help break transmission links by identifying those who may be carrying the virus unknowingly.

First Name* Last Name* Tutor Group*

I give consent for my child to be tested onsite at the Academy*YesNo (no straight to ‘submit’ at bottom of page)

Date of Birth

Gender (this information is needed for Department for Health and Social Care research purposes.)MaleFemale

Ethnicity (this information is needed for Department for Health and Social Care research purposes.)Asian or Asian BritishBlack, African, Black British or CaribbeanMixed or multiple ethnic groupsAnother ethnic backgroundWhitePrefer not to say

Currently showing any COVID-19 symptoms?YesNo

Postcode First Line of Address Parent Email Address – this is where test results will be sent Parent Mobile Number – this is where test results will be sent. Please do not put a landline number – you can only receive test results to a mobile number. Name of parent/guardian giving consent Relationship to test subject Signature (typing out your name is sufficient if you are filling in this form digitally) Today’s date Details of any health or accessibility issues which might affect a child’s safe participation in the testing exercise.

LFD Testing

LFD Consent Form

The Bourne Academy, Hadow Rd, Bournemouth, BH10 5HS.

T 01202 528554 • E admin@thebourneacademy.com

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T 0345 222 2323 • E enquiries@schoolsplus.co.uk

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