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Hamilton School COVID Reporting Form
Parents/Guardians: please complete this Form as soon as possible so we can take the necessary precautions to help prevent additional virus exposure. Please complete a separate form for each student.
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* Indicates required question
Email
*
Your answer
Student's Last Name
*
Your answer
Student's First Name
*
Your answer
Student's Grade
*
Kindergarten
First Grade
Second Grade
Third Grade
Fourth Grade
Student's Homeroom Teacher(s)
*
Your answer
Which would you like to report?
*
My child has tested positive for COVID 19
My child has symptoms of COVID 19
My child has been in close contact to a COVID 19 positive case
Someone in our home has tested positive for COVID 19
Is your child fully vaccinated?
*
Yes
No
Last Day in School
*
MM
/
DD
/
YYYY
Date symptoms first appeared
*
MM
/
DD
/
YYYY
Symptoms
*
Your answer
Exposure date (if known)
*
Your answer
Location of exposure (if known)
*
Your answer
Date of Positive Test
MM
/
DD
/
YYYY
Please list any siblings in the district and their current school. Please indicate whether the sibling is fully vaccinated as well.
Your answer
Do you have any names of potential close contacts? (ie. bus, lunch, team) Close contact is identified as being within 3ft for 15 minutes or longer.
*
Your answer
Can your student isolate at home?
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Yes
No
Please list a contact number in case we have additional questions/concerns.
*
Your answer
Do you need a school nurse to call you regarding your situation?
Yes
No
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