Positive Covid Case Information
Please help us gather information to support a healthy and safe return to school. This information is mandatory for a return to school date for your child.
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Email *
Student First Name (not nickname) *
Student Last Name *
Student ID # *
Student Email Address *
Parent(s) Email Address *
Grade *
Vaccination Status *
Date COVID19 test collected *
MM
/
DD
/
YYYY
Type of test result received *
Have you experienced any symptoms? *
Date symptoms started
MM
/
DD
/
YYYY
Are you involved in a CCHS extra curricular activity? *
Last date you participated in CCHS extra curricular listed above
MM
/
DD
/
YYYY
Do you have a sibling who attends CCHS *
Please List Siblings (If any)
Sibling #1 Last Name
Sibling #1 First Name
Sibling #1 Vaccination Status
Clear selection
Sibling #2 Last Name
Sibling #2 First Name
Sibling #2 Vaccination Status
Clear selection
Sibling #3 Last Name
Sibling #3 First Name
Sibling #3 Vaccination Status
Clear selection
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