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COVID 19 Positive and Close Contact Self Reporting
Please use this form to self report a new positive COVID 19 result or close contact.
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* Indicates required question
Student Name(s)
*
Your answer
Parent/Guardian Name
*
Your answer
Parent/Guardian Phone Number
*
Your answer
Parent/Guardian Email Address
Your answer
Has your child or anyone in your household received a test confirmed positive for COVID 19 within the last 2-5 days?
Yes
No
Clear selection
Has your child or anyone in your household been considered close contact for COVID 19 within the last 2-5 days?
Yes
No
Clear selection
Please provide any additional information.
Your answer
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