LaGrange Highlands School District 106

LaGrange-Highlands School District No. 106 (the “District”) is offering a program to perform a non-diagnostic COVID-19 “RT-LAMP” surveillance assay (“Surveillance”) as part of the District’s efforts to maintain a safe environment for our school community. This Surveillance is being used as one part of the District’s overall safety protocols that includes masks, social distancing, cleaning, and other mitigation strategies.

To perform this non-invasive Surveillance, the student being screened will deposit a small amount of saliva in a sterile container at home. The container should then be wiped clean, placed in a sealable plastic bag, and returned to the District with the student where it will be collected. The saliva will then be screened for the presence of COVID-19. Saliva samples will be used solely for the purpose of performing the Surveillance and then destroyed following surveillance in a manner appropriate for biological specimens. Individual results of the surveillance will not be published under any circumstances.

In the event the Surveillance indicates a potential presence of COVID-19, the individual will be notified of “findings of potential clinical significance.” Parents will not be contacted if the student receives a negative result.

Because of the ongoing public health crisis, the District will treat findings of potential clinical significance using this surveillance tool the same way that the District will treat the outcomes of other surveillance measures it is using, such as symptom screening, temperature measurements, and observable COVID-19 like symptoms.

Thus, if the screener indicates there is a potential presence of COVID-19, the individual will be required to stay home from school and self-isolate until cleared through an FDA approved diagnostic test or otherwise complied with IDPH guidance on required quarantine and return to work/school protocols.

If you have any questions about the Surveillance, please contact the school nurse or feel free to discuss the proposed surveillance with your physician.

By entering information below and submitting it to the District, you...

(1) voluntarily consent for your child to participate in the non-diagnostic detection of a clinically significant finding that could indicate the presence of COVID-19; and

(2) voluntarily consent for your child to participate in the collection of saliva for the sole purpose of running this program; and

(3) understand and consent to District employees or volunteers distributing Surveillance kits to you or your student at school or at your home; and

(4) voluntarily consent to the disclosure of findings of clinical significance to the District Nurse’s office which will be maintained as a student or medical record in the same manner that the District currently maintains other student or medical records such as immunizations and physicals; and

(5) acknowledge that the results of the Surveillance should not be used as the sole basis, or any definitive basis, to diagnose or confirm COVID 19 or inform infection status and that no surveillance is 100% accurate; and

(6) acknowledge that you release, promise not to sue, hold harmless, and indemnify the District from any claims (including legal costs) arising out of the participation in the Surveillance, brought by the student or a third person, including but not limited to any inaccurate Surveillance results.

If at any time you choose to revoke consent as provided here, the District must receive revocation in writing indicating your desire to revoke your consent for you or your child to participate in the administration of the Surveillance as detailed here.