Hills Chapel Elementary Prentiss County School District Student Notification of Direct Close Contact Exposure of COVID-19, a Person Living in your Household has Tested Positive for COVID-19, or if Student has Tested Positive for COVID-19.

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This form is to notify Prentiss County School District if your Child has had Direct Close Contact, which is defined as being six (6) feet of a COVID-19 Positive Person for longer than 15 minutes without a mask/facial covering. If a person living in your household has tested positive for COVID-19 or if Student has Tested Positive for COVID-1

Email *

I need someone from Prentiss County School District to contact me to discuss that my child has had Direct Close Contact of a COVID-19 Positive Person If a person living in your household has tested positive for COVID-19 or if Student has Tested Positive for COVID-19. *

Yes

Which campus in Prentiss County School District my child is located at? *

Hills Chapel

Please mark this check box if your child is enrolled in the Distance Learning Program and mark the campus your child was registered

Required

I verify that I am the legal guardian of a student in Prentiss County School District *

Yes

Required

Parent/Guardian Name and Contact Information (telephone number) *

Date *

YYYY

I am entering this information for a students family and I am an Employee of Prentiss County School District who is reporting this. (Yes/No) (Name of Employee)

What date did the member of the household test positive for COVID-19, student, or have direct close contact interaction?

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