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COVID-19 Positive Case Reporting Form
If your child has tested positive for COVID-19, please complete this form. Data from this form will be forwarded to the CSD Nursing staff. Thank you for completing the form.
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* Indicates required question
Email
*
Your email
Parent/Guardian Name
*
Your answer
Parent/Guardian Phone Number (To be used for communication between school and home)
*
Your answer
Secondary Parent/Guardian Name
Your answer
Secondary Parent/Guardian Phone Number (To be used for communication between school and home)
Your answer
Student Name
*
Your answer
Student School
*
Your answer
Date of the start of symptoms
MM
/
DD
/
YYYY
Child's most recent date in school?
*
MM
/
DD
/
YYYY
How was your child tested?
*
Rapid Test
PCR Test
Date of Test
*
MM
/
DD
/
YYYY
Send me a copy of my responses.
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