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COVID-19 In-Home Exposure School Reporting Form
Parents, please fill out the following Google Form to document your child's IN-HOME EXPOSURE to COVID-19.
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* Indicates required question
Student Last Name
*
Your answer
Student First Name
*
Your answer
Student's Date of Birth
*
MM
/
DD
/
YYYY
Student Homeroom
*
Choose
Camp Corral Camper
Teenies A
Teenies B
Tweenies A
Tweenies B
Toddlers A
Toddlers B
Toddlers C
Pre-3A
Pre-3B
Pre-3C
Pre-3D
Pre-4A
Pre-4B
KA
KB
1A
2A
3A
3B
4A
5A
6A
6B
7A
7B
8A
9th
10th
11th
12th
ACA Employee
Date of COVID-19 Exposure
*
MM
/
DD
/
YYYY
Was the student exposed by someone in their immediate household (parent, sibling, someone that lives in same home as student)?
*
Yes
No
Parent Last Name
*
Your answer
Parent First Name
*
Your answer
Parent Phone Number
*
Your answer
Submit
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