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Driggers - Student COVID Data Entry Form
Please complete the following form to report suspected or confirmed cases of COVID 19.
----------------- Student Registered Email Only! -------------------------
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* Indicates required question
Email
*
Your email
Student Name
*
Your answer
Student ID #
*
Your answer
What Grade is the Student ?
*
Choose
EE
PK
Kinder
1st
2nd
3rd
4th
5th
Parent/Guardian's Name and Relationship to student: Last Name, First Name, Relationship (Mother, Father, Grandparent, Guardian, etc)
*
For Example : Vasquez, Angelica / Mother
Your answer
Parent/Guardian's - Phone Number
*
(Area code) (Phone Number) xxx-xxx-xxxx
Your answer
Has your student had a known exposure to COVID 19 in the last 2 weeks? Select Yes or No.
*
Yes
No
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