WCSD COVID-19 Reporting Form

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The Wickliffe City School District is providing this reporting form to assist District staff in monitoring COVID -19 in our schools.

Please complete this form if you are the parent or guardian of a Wickliffe City School District student who has tested positive for COVID-19.

Email *

Last name of the student who has tested positive for COVID-19. *

First name of the student who has tested positive for COVID-19. *

Grade level of the above-listed student. *

Date of first COVID symptoms

If asymptomatic (no symptoms) skip to the next question.

YYYY

Date of the positive COVID-19 test result. *

YYYY

Has your physician or the Lake County General Health District given you a return to school date for your child? If so, what is that date?

If no date was provided, skip to the next question.

YYYY

Name of the person completing this form. *

Relationship of the reporting adult to the above-named student. *

Parent/Guardian

Family Member (not parent or guardian)

Other:

Phone Number of reporting adult *

Are there other Wickliffe Schools' students residing in your home? *

Check the COVID Information & Reporting page on the WCSD website for more information, including modified school exclusion periods that may apply to your situation. All students must be symptom-free before returning to school.

Yes

Does the above-named student participate in school-sponsored athletics, extra-curricular, or co-curricular groups (i.e. band, choir, and clubs)? *

Yes

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