CPS Nurse Office COVID Information
Parents/Guardians
Thank you for helping keep CPS healthy.  You should fill out this form only if your child has signs/symptoms of illness, has received a COVID-19 test and is awaiting results, or has had a positive COVID-19 test in the last 14 days.   Please keep your child home until you have heard from your school via email or phone call. --
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Email *
Student First Name
Student Last Name
Parent/Guardian Name
Parent Phone Number To Discuss Symptoms/Exposure
Grade of Student
Homeroom Teacher
Does your child ride the bus?
Please list any CPS sponsored athletics or activities in which your student currently participates, if applicable. --
Does your student have any siblings @ CPS? If yes please provide name and grade.
Is your student currently experiencing any symptoms?
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If you answered that your student is experiencing symptoms, when did they begin?
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Please check which symptoms your child is having
If you answered that your student has had a known exposure in the last 14 days to someone positive for COVID-19, on what date did contact last occur?
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Has your student recently been tested for COVID?
If yes, when was the COVID test sample collected?
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If your student was tested for COVID, what were the results?
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When was your student last at school? (for in person learning, sports, etc)
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Please add any additional details you feel would be helpful to determine your student's return to school date. --
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