LBUSD Student COVID Case Questionnaire
Please enter the following information for reporting purposes. You will receive an email with appropriate guidance including return to school dates once the information is processed. Thank you!
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Email *
Student's First and Last Name *
Student's Date of Birth *
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Parent/Guardian First and Last Name *
Parent/Guardian Email (guidance will be sent to this email address) *
School of Attendance
Please indicate your child's school of attendance and indicate if they take district transportation.
 *
Required
Does the student have symptoms of COVID-19? *
Date of onset of symptoms (leave blank if asymptomatic)
Please double check your date (day, month, and year) when submitting.
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Date the student tested POSITIVE for COVID-19
Please double check your date (day, month, and year) when submitting.
 *
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Was your student exposed to someone with COVID-19 prior to testing positive? If so, please indicate the location of the exposure:
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Date that student was last on school campus (including athletics and other activities)*
Please double check your date (day, month, and year) when submitting.
 *
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Does your student participate in high school athletics or in an after-school program? If so, please state the team or program. (If No- leave blank)
Any Additional Comments
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