Staying Safe during COVID-19 on CDS Campus

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Please fill out this form when your child is sick or has had close contact with a positive COVID case. You will receive a copy of your responses by email. You can return to the form to update it after you have submitted it.

If your student is sick with a cough, a cold, a fever, or other symptoms described below, or has had close contact with a positive COVID case, do not come to school. Contact your physician for guidance. Do not return to school until your physician tells you it’s all right to return, or you have received confirmation from CDS.

Email *

Student name *

Student grade/cohort/teacher *

Date of onset of symptoms or date of positive COVID test or date of last contact with positive COVID case *

YYYY

1. Within the last 10 days has your student been diagnosed with COVID-19 or had a test confirming they have the virus? *

Yes

2. Does your student live in the same household with, or had close contact* with someone who in the past 14 days has been in isolation for COVID-19 or had a test confirming they have the virus? *You are a close contact of a COVID-19 positive person if, from 48 hours before their symptoms began or received a positive COVID test/diagnosis, the person with COVID-19 was within 6 feet of you for a cumulative total of 15 minutes or more over a 24-hour period.

Yes

Clear selection

If you responded YES above, your student must quarantine for at LEAST 7 days, provided they have a COVID test on day 5 or later, and the result is negative, and no symptoms have developed. With no COVID test, your student must quarantine for at least 10 days, provided no symptoms develop. *

above response was NO

Required

My student absence is due to the following symptom(s) *

CDS data - please CHECK AS MANY BOXES AS APPLY.

Fever (100.4°F/38°C or higher)

Cough (for children with chronic cough from allergies or asthma, a change in their cough from baseline)

New onset of headache

Sore throat

Loss of taste or smell that started in the last 10 days. Children may say that food “tastes bad” or “tastes funny”

Difficulty breathing (for children with asthma, a change from their baseline breathing)

Nasal congestion or runny nose

Diarrhea, nausea, or vomiting

Fatigue

Muscle aches or body aches

Close contact with a positive COVID case

Other:

Required

My student illness is not COVID-related (does not have ANY of above symptoms)

Non-COVID-related symptoms

If your student has any of the above symptoms, or COVID -19 contact, they may have COVID-19 and must be tested for the virus before returning to school. Without a test, CDS must treat this as being positive for COVID-19 and require your student to stay out of school for at least 10 calendar days. In order to return sooner and to protect others, your student must get tested for the virus. Provide your testing date below:

Test Results

Positive (confirms that you have the virus)

Negative (indicates that you do not have the virus)

Waiting for test results (you must return to form to provide result)

Clear selection

Negative result requires follow-up. If your result is negative, your student can return to school after they have had at least 24 hours in a row without fever and with improvement in other symptoms. Consult with your healthcare provider to decide, and please attest to the following: *

My child will not return to school until all symptoms have resolved and they are fever-free for 24 hours without use of fever suppressing medication.

I live with a positive COVID 19 individual. I will follow home quarantine steps as prescribed.

Required

Positive result requires follow-up. If the result is positive, please share with covid@cds-sf.org in order to plan your return to school and get support. *

I pledge to follow the Isolation Steps.

Required

A copy of your responses will be emailed to the address you provided.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This form was created inside of Children's Day School. Report Abuse

Forms