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Bristol Public Schools: Launching into Healthy Learning 8/22
This form is to be completed by BPS parents or guardians of a student, or an employee to report positive COVID -19 status.
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Email
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Your email
In the space below type your child's first name. If an employee, type your first name.
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Your answer
In the space below type your child's last name. If an employee, type your last name.
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Your answer
In the space below, enter your child's date of birth. If you are an employee, enter your date of birth (month/day/year).
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MM
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DD
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YYYY
Enter your child's grade level.
Your answer
I am completing this form as:
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Parent/guardian of BPS student.
BPS employee
Todays date is:
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MM
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DD
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YYYY
My child tested positive for COVID-19 on (enter date of test). If you are an employee, enter the date of the positive COVID-19 test result:
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MM
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DD
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YYYY
Enter the date of onset of COVID symptomology (if symptomatic).
MM
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DD
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YYYY
Select the appropriate response regarding symptomology below:
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COVID-19 symptoms are mild
COVID-19 Symptoms are severe
No COVID-19 symptoms are present
Required
I can be reached by phone at:
Your answer
Send me a copy of my responses.
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