Mt. Healthy City School District Health Form

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In order to provide the most up-to-date information to Hamilton County Public Health Department and contact tracing, we are requesting that parents complete the form. If anyone in your household has been exposed or had close contact to someone with COVID 19, tests positive for COVID 19, or shows any symptoms for COVID 19, please complete the following form to allow us to trace any other contacts to your children within the school community. We appreciate your assistance with this.
Your personal and medical information you provide will be kept completely confidential and will only be shared with Hamilton County Public Health Department for contact tracing purposes.

Email *

Parent or Guardian Legal Name (first and last) *

Which would you prefer to be contacted? *

phone

Other:

Please provide the phone number or email where you maybe reached if we or HCPHD need to contact you. *

Do you have a child who has had close contact or was exposed to someone diagnosed with COVID 19 outside of Mt. Healthy City School District? *

Yes

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