Westfield Area School District - Student COVID-19 Form For Parents to Complete

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This form will help determine the next steps for your student and his/her return to school date, based on exposure, symptoms and/or test results.
After you submit this form, the school nurse will contact you to follow up.
If you have not heard back within 24 hours, please call the school nurse.

Email *

Your student's first and last name *

Your student's date of birth *

YYYY

Does your student attend school in person or virtually? *

In Person

Virtually

What school does your child attend?

What grade is your student in?

Does your student participate in any extracurricular activities, such as any school athletics or clubs? *

Yes

Does your student have any siblings in the district?

Yes

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Does your student ride the bus to or from school? *

Yes

What was the last date your student was in the district (attended school or extracurricular activities)? *

YYYY

Name of the person filling out this form *

Best phone number to reach you for follow-up *

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