Lateral Mass Testing Consent

Child's First Name

Last Name

Date of Birth

Year Group

Please indicate your child's year group

Gender

This information is required for Department of Health & Social Care research purposes

Male

Female

Ethnicity

This information is required 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

Currently showing any COVID-19 symptoms?

Yes

No

Has your child registered on the NHS Track and Trace site?

Yes

No

Address Line 1

Post Code

Parent/Carer's Email Address

Child's Mobile Number

Name of Parent/Carer giving consent

Relationship to test subject

Signature

Date

Consent

I consent to my child participating in lateral flow testing