STUDENT POSITIVE COVID-19 CASE REPORT
Parents complete this form in lieu of an email or phone call when your child has tested positive for COVID-19.
THIS DOES NOT SERVE AS ABSENCE NOTIFICATION.  PLEASE CALL THE ATTENDANCE OFFICE TO REPORT YOUR CHILD'S ABSENCE.
Thank you for informing us, as this is the only way that we can adequately track any potential outbreaks within our school community.
UPON COMPLETION OF THIS FORM, YOU WILL RECEIVE AN EMAIL FROM ARCHBISHOP WOOD HEALTH SERVICES WITHIN 24 HOURS TO PROVIDE LENGTH OF ISOLATION AND RETURN TO SCHOOL.
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Email *
Please list name of parent completing this form: *
Home School District: *
Student Last Name *
Student First Name *
Grade *
Parent Phone Number
Symptoms: yes or no *
Symptom Onset Date *
Exposure through: *
Vaccinated? *
Booster Shot Received? *
Type of test *
Date of test *
MM
/
DD
/
YYYY
Date of last day in school *
MM
/
DD
/
YYYY
Sport/Activity? Please list if yes *
Does the student ride a bus to school *
Any other pertinent information
Submit
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