JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Student Positive COVID CASE Information (please complete one per child)
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Child's First Name
*
Your answer
Child's Surname
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Class Name
*
Choose
Prep EF
Prep P
Prep M
1 T
1 B
2 J
2 F
3 L
3 B
3 G
4 R
4 G
5 M
5 R
6 M
Date Last at School
*
MM
/
DD
/
YYYY
Parent First Name (only one parent needed)
*
Your answer
Parent Last Name
*
Your answer
Parent Email Address
*
Your answer
Symptoms
*
Choose
None
Symptomatic
Asymptomatic
Unknown
Test Type
*
PCR
RAT
Required
Positive Test Date
*
MM
/
DD
/
YYYY
Symptoms Onset date(if unknown / no symptoms put test date)
*
MM
/
DD
/
YYYY
Exposed / Infected out side of school
*
Choose
Yes
No
Unknown
Exposed /Infected at School
*
Choose
Yes
No
Unknown
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Galilee Regional Catholic Primary School.
Report Abuse
Forms
