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Pierz Schools 2021-22 Confidential Health Form
Please fill out one form for EACH child you have attending Pierz Schools. A link to submit another form will pop-up after you submit each form.
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* Indicates required question
Email
*
Your email
Student First Name
*
Your answer
Student Last Name
*
Your answer
Student Date of Birth
*
MM
/
DD
/
YYYY
Grade
*
Choose
PK
K
1
2
3
4
5
6
7
8
9
10
11
12
Doctor/Clinic:
*
Your answer
Has this child ever tested positive for COVID-19?
*
No
Yes
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