You may also find additional information at This FAQ gives you information about the Program, including the process for testing, the benefits and limitations of testing, how your private information will be protected, and the process for notifying you of test results. You may reach out to your school or school district representative overseeing the testing program or if you have any questions. (“Testing Partner”) Your School District has opted to participate in the Program, which is a FREE COVID-19 PCR saliva testing for our schools’ teachers, students, and staff. The NJDOH is sponsoring the Program, along with its lab testing partner: Mirimus Inc. The State of New Jersey, acting through the New Jersey Department of Health (”NJDOH”), is sponsoring the New Jersey Schools COVID-19 Screening Testing Program (the “Program”) for all schools and school districts in New Jersey. Signature or Parent/Guardian signature if Student is under the age of 18. By signing this form, I acknowledge that I have read and accept all of the above. I have read this form and all of my questions have been answered to my satisfaction. I will receive positive test results and will take appropriate actions. I understand and acknowledge that NJDOH, its contractors, and the school/district are not acting as the medical provider and this Program is not for testing if a person is sick or exposed to a person with COVID-19. Has passed since the positive test result. I understand that if my child/legal guardian/I have tested positive for COVID-19 within the last 90 days, my child/legal guardian/I will not be able to participate in the Program until 90 days I understand that I have the right to revoke this consent at any time by notifying in writing the school nurse or whomever the school designates in writing to receive such notice. I authorize the release of information as indicated in the Frequently Asked Questions as part of the Program for public health purposes.īy signing this, I am giving permission for my child/legal guardian or myself to participate in this voluntary testing Program. I understand there will be no cost to me for this testing Program. I have read and understand the attached Frequently Asked Questions about the New Jersey Schools COVID-19 SCREENING TESTING PROGRAM (the “Program”). I authorize the New Jersey Department of Health, (the “NJDOH”) and it contractors to receive self-collected saliva samples on the above named individual and conduct COVID-19 screening tests on those samples.
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