WSHS Student COVID Reporting

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This form is for the purpose of retrieving necessary information for completing COVID-related student reports. The information submitted through this form will only be accessible by authorized school officials for the purpose of accurate documentation of positive and contact cases.

Parent name *

Parent email *

Student name
*

Student tested positive or exposed to someone who tested positive.
*

Tested Positive

Exposed to someone who tested positive

Who exposed student (mother, father, cousin)? Date exposed

Date symptoms began
*

YYYY

COVID test date
*

YYYY

Testing location of test, (at home, Dr. office, etc..)
*

Last day student was at school
*

YYYY

Does the student ride the bus? What is the student's bus number?
*

Has the student been vaccinated?
*

Yes

Other:

Date student was vaccinated.
*

YYYY

Does the student participated in any after school activities? Band, sports, clubs, etc..
*

Does the student have any siblings that go to another MSCS school. What is the student's name, grade and school?
*

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