COVID-19 Reporting Form
Any and all personally identifiable information you provide is confidential.  Our school nurse will follow up with you to discuss your situation and provide guidance, if needed.


Sign in to Google to save your progress. Learn more
Email *
What is your name? (First and Last) *
What is your phone number? *
Please define your relationship to York Academy (Check all that apply) *
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of York Academy Regional Charter School. Report Abuse