Consent Form for COVID-19 Testing

What is this form?
We are seeking your consent to test your child for COVID-19 infection due to exposure. Calvary Academy has partnered with the University of Illinois and SHIELD of Illinois to test students, teachers, and staff members for COVID-19 infection. This test is to potentially prevent your child from being quarantined due to exposure of a COVID-19 positive patient. If you do not consent to your child being tested for COVID-19, your child could be placed on a quarantine due to Covid-19 infection or exposure. Students that are fully vaccinated will not need further testing if exposed to COVID-19. 

What is the test?
If you consent, your child will receive a free diagnostic test for the COVID-19 virus conducted by collecting saliva (spit). There is no cost to you or to Calvary Academy. If your child is exposed to COVID-19, Calvary Academy will offer the four-part testing series to students on days one, three, five, and seven from exposure. 

How will I know if my child tests positive?
You will receive access to your child’s test results via an online platform. You will receive more information about this platform in future  correspondence. Calvary Academy will also receive the results of your child’s test and will notify you separately of any positive result. All results are confidential and protected under HIPAA and FERPA. 

What should I do when I receive my child’s test results?
If your child’s test results are positive, please contact your child’s doctor immediately to review the test results and discuss next steps. You may not send your child back to school until they are symptom free and their quarantine has been completed. 

If your child’s test results are negative, this means that the COVID-19 virus was not detected in your child’s saliva (spit). Your child may continue to attend school and participate in extracurricular activities during the four-part testing series as long as they continue to test negative.

Tests sometimes produce incorrect negative results called “false negatives” in people who have COVID-19. If your child tests negative but has symptoms of COVID-19, or if you have concerns about your child’s exposure to COVID-19, you should call your child’s doctor. 

Who will receive my child’s test results?
In addition to you receiving your child’s test results, Calvary Academy and the Illinois Department of Public Health (“IDPH”) will also receive your child’s test results, consistent with IDPH guidance and the Illinois Control of Communicable Disease Code.

I consent for my child(ren) named above to be tested for COVID-19 infection.
I have signed this form freely and voluntarily, and I am legally authorized to make decisions for the child(ren) named above.
I understand that this consent form will be valid through the 2021-2022 school year.
I understand that my child's test results and other information may be disclosed as permitted by law and are protected by HIPPA and FERPA.

*** You must have JavaScript enabled to use this form ***


1730 West Jefferson St.

Springfield, IL 62702

Get Directions

Phone: 217-546-5987

Fax: 217-321-1063

Contact Us