SIS ICATT Student Consent Form Posted by Amber Woods Student's Name* First Last Has the student listed above been diagnosed with COVID-19 in the past 90 days?*Yes, my child has tested positive for COVID-19 in the past 90 days (note: individuals who have tested positive for COVID-19 in the past 90 days should not participate in the ICATT testing program).No, my child has not tested positive for COVID-19 in the past 90 days.Date of Positive Test Result Date Format: MM slash DD slash YYYY Grade Level*Select3rd Grade4th Grade5th GradePrimary Homeroom Teacher's Name*Date of Birth* Date Format: MM slash DD slash YYYY Sex*SelectMaleFemalePrefer not to specifyRace*SelectBlack or African AmericanWhiteAsianAmerican Indian/Alaska NativeNative Hawaiian/Other Pacific IslanderOther RacePrefer not to specifyEthnicity*SelectHispanic or Latino/aNot Hispanic or Latino/aPrefer not to specifyAddress* Street Address City State / Province / Region ZIP / Postal Code Parent/Legal Guardian #1 Name* First Last Parent/Legal Guardian #1 Phone*Parent/Legal Guardian #1 Email* Enter Email Confirm Email Parent/Legal Guardian #2 Name First Last Parent/Legal Guardian #2 PhoneParent/Legal Guardian #2 Email Enter Email Confirm Email By filling out this form, you agree to consent to have your child tested, and that you have read and understood the consent form.Signature*I, the undersigned, have been informed about the test purpose, procedures, possible benefits, and risks, and I have read and understood the Informed Consent. If you need to fill out a consent form for another child, please return to the ICATT Student Consent Form page. Formulario de Consentimiento del Estudiante de ICATT