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Travel and Contact Reporting Form
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* Indicates required question
Email
*
Your email
Name
*
Your answer
Child's Name
Your answer
Child's Grade
Your answer
If someone in your household has traveled to a country outside of the United States in the past month, what country was visited?
Your answer
If anyone in your household has visited or plans to visit another state, what city and state was or will be visited?
Your answer
Has anyone in your household had an illness in the past two weeks?
*
Yes
No
Any other information we should be aware of:
Your answer
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