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Student Positive COVID Form - Use this form to submit a report to your child's school nurse that your child is COVID positive.
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* Indicates required question
School child attends
*
Choose
Fort Meadow
Abner Gibbs
Franklin Avenue
Highland
Munger Hill
Paper Mill
Southampton Road
Westfield Intermediate School
Westfield Middle School
Westfield High School
Westfield Technical Academy
Westfield Virtual School
Grade
*
Choose
Pre K
K
1
2
3
4
5
6
7
8
9
10
11
12
13
For children in grades PK - 4, please indicate classroom teacher's name.
Your answer
Child Last Name
*
Your answer
Child FIrst Name
*
Your answer
Please indicate date the test was administered
*
MM
/
DD
/
YYYY
If your child is symptomatic, please indicate the date of symptom onset
MM
/
DD
/
YYYY
PCR Test or Rapid Home Test
Choose
PCR
Rapid Home Test
Both
Parent / Guardian Name completing this form
Your answer
Phone Number
Your answer
Additional information you would like to include:
Your answer
Submit
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