Consent form for COVID-19 testing in secondary schools

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* 1. First Name (of Student)

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* 2. Last Name (Surname of Student)

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* 3. Year Group

7

8

9

10

11

Sixth Form (12/13)

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* 4. Date of Birth (Student)
Please scroll down to the next question, once DOB has been entered.

DOB

Date

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* 5. Gender (of Student - this information is needed for Department for Health and Social Care research purposes.)

Male

Female

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* 6. Ethnicity (of Student - this information is needed for Department for Health and Social Care research purposes.)

Asian or Asian British

Black, African, Black British or Caribbean

Mixed or multiple ethnic groups

White

Prefer not to say

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* 7. Is the student currently showing any COVID-19 symptoms?

Yes

No

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* 8. Do you have other children at Blue Coat CE Academy?

Yes

No