COVID positive case reporting form- STUDENT
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Adresă de e-mail *
Student name (first and last) *
Grade of child *
Did your child experience any symptoms? *
If applicable, what date did symptoms appear?
ZZ
/
LL
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AAAA
If applicable what symptoms did your child have?
What was the last date your child was on campus?
ZZ
/
LL
/
AAAA
Did your child take a COVID test? *
If so, what was the date of the test?
ZZ
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LL
/
AAAA
Is your child fully vaccinated? *
If applicable, what date did they receive the first dose of the vaccine?
ZZ
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LL
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AAAA
If applicable, what date did they receive the second dose of the vaccine?
ZZ
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LL
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AAAA
Do you give the school permission to share the name of your child when reporting the positive case?
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Acest formular a fost creat în domeniul St. Francis de Sales School. Raportează un abuz
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