SPS BINAXNOW CONSENT

Contact Information

Parent/guardian of child being tested
Name(Required)
Address(Required)
Best way to contact you(Required)

Demographic Information about the Student Being Tested

Demographic information is needed to comply with Arizona Department of Health Services and Pima County Health Department reporting requirements.
Student's Name(Required)
MM slash DD slash YYYY
Gender(Required)

Race(Required)

Your Consent

I consent to the administration of the Abbott BinaxNOW COVID-19 Antigen Card by Sahuarita Unified School District for my child named above. I certify each of the following:
Consent(Required)
Consent(Required)
Consent(Required)
Consent(Required)
Consent(Required)
Consent(Required)
Consent(Required)
Consent(Required)
By signing, I acknowledge that I understand and agree to all statements checked above.
Parent/Guardian Name(Required)