Reporting a student who has COVID-19

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Please complete and submit this form for each student who has received a positive lab result for COVID-19. This information will remain confidential, and will assist our school nursing staff in determining outbreaks. You may be contacted by a registered nurse from the School District.

Even if the student was not present in school before they showed symptoms or began an isolation period at home, please let us know if they have tested positive so that our health and attendance records are complete.

Email *

School *

What school does your child attend?

Student *

First and last name of student

Date of Birth *

Student's date of birth

YYYY

Grade *

Student's grade level

Parent *

Parent's first and last name or person submitting this form

Phone Number *

Phone number of parent or person submitting this form

Date student was tested *

YYYY

Household Members *

Are any other household members part of the Coeur d'Alene School District?

Yes

Notes

Is there anything else you believe we should know, including the names of any siblings or household members, if part of the Coeur d'Alene School District?

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

Submit

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