Sahuarita Unified School District SIS ICATT Student Consent Form

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*
Primary Homeroom Teacher's Name*
Date of Birth*
Date Format: MM slash DD slash YYYY
Sex*
Race*
Ethnicity*
Address*
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 Phone
Parent/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.