Handle with Care 
This form is for reporting officials ONLY.

Please fill out this form to help Conrad Public Schools better serve our students by letting us know when a student has been involved in a traumatic event or accident. We will use this information to support this student and ensure his or her needs are being met at school.

Fill out one form per student. This information will be sent to the school counselors and principals and will be kept confidential.

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Students Name: First + Last - If more than one please list each child *
Students School/Grade: *
Required
Incident Date *
MM
/
DD
/
YYYY
Reporting Agency *
Contact Information of Reporting Person -             Full Name & Number *
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