Consent Form for Covid Testing at School

Effective the week of November 16, 2020, New York State began to require that schools in designated Yellow Zones that wish to remain open for in-person learning conduct random COVID-19 testing.  Within a given Yellow Zone, it is required that 20% of in-person students, faculty and staff be randomly tested over the two week period immediately following the designation.  The Mount Pleasant Central School District is prepared to offer COVID-19 testing to students, faculty and staff in order to remain open for in-person learning if Hawthorne or Thornwood postal codes are designated a Yellow Zones.  

In order for students to participate in the COVID-19 testing protocol, parental consent is required.  Please complete the consent form, which will indicate your preference:

  • Tested without the parent present;
  • Tested with the parent present.

You can return your consent form in one of two ways:

  • Print, sign and scan the form to mtimms@mtplcsd.org
  • Print, sign and place in a sealed envelope and return it to the school nurse clearly labeled on the envelope “Covid-19 Testing Consent Form.”

If you have provided consent to test your child without your presence and your child is randomly selected as part of the 20% in-person population, a parent will be notified via email with specific information on logistics of how the test administration will occur during the school day.  

If you have provided consent to test your child with your presence only and your child is randomly selected as part of the 20% in-person population, a parent will be notified via email with a designated time/location on campus when testing is available outside of school hours.  It will be important that parents adhere to their appointment times and locations so that mandatory social distancing and other health measures may be preserved at all times. 

Following the administration of the test, you will be notified of a positive result only by telephone, no later than the end of the same day.  If you do not receive a phone call by the end of the day which you are tested, you can presume that your child’s test was negative. The results of the rapid antigen test are strictly confidential.  The school district will only report the test results to the New York State Department of Health through the Electronic Clinical Laboratory Reporting System (ECLRS), as required by the state for purposes of documentation of the required testing. 

If you have any questions regarding the district testing process, you should contact Ms. Donna Pirro, Director of Health, Physical Education and Athletics at dpirro@mtplcsd.org.