UCSD Covid App

First Name Last Name I am registering as/for an adult 18 years or older
a child 13-17 years old
a child 7-12 years old
a child 2 to 6 years old

Dr. Louise Laurent and their research team are doing a research study to find out more about COVID-19 in children and their families or friends. You are being asked if you want to be in this study because you are a child who lives or goes to school in the Central and South San Diego community

If you decide you want to be in this research study, this is what will happen to you:

We will ask you to swab your nose to test if you have COVID-19.

Sometimes kids don't feel good while being in this study. You might feel these things:

If your nose is swabbed, it may tickle your nose. Some kids think it is uncomfortable.

If you feel any of these things, or other things, be sure to tell your mom or dad.

You don't have to be in this research study if you don't want to. Nobody will be mad at you if you say no. Even if you say yes now and change your mind after you start doing this study, you can stop and no one will be mad.

Be sure to ask Dr. Laurent or their research team to tell you more about anything you don't understand.

Do you agree to participate in this study? (For Child) Yes No

Please write name of child here: Do you agree to be contacted for further research? Yes No

Date of Birth