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COVID19 Report Form
This form is available 24 hours a day to send a notification to school administration that your child or a household member have tested positive for COVID19 or has multiple symptoms of COVID19. In order to be able to help the county with contact tracing, please fill in all fields so we can do follow up. We will have a release form for you that will allow us to talk to the county.
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* Indicates required question
Email
*
Your email
Your Name
*
Your answer
Your Child's Name
*
Your answer
Who has tested positive for COVID19 or has been quarantined?
*
My Child
Another Household family member
Required
Which county did you test positive in?
*
Bates
NE Vernon
None. Just exhibiting multiple symptoms.
Required
Please provide us with a phone number to contact you:
*
Your answer
Please check two or more symptoms which your child is exhibiting:
*
Loss of Taste or Smell
Blue Toes
A New Cough
Difficulty Breathing
Oral Temp of 100.4 or more
Sore Throat
New uncontrolled cough or a change in a chronic cough (from asthma, etc) from baseline
Diarrhea, vomiting, or abdominal pain
Congestion/runny nose
Muscle or body aches
My child isn't exhibiting any symptoms at this time
Required
Can we email you the county medical release form?
*
No, I don't have a way to print it
Yes, I can print it and return it or have you pick it up
Yes, I can print it, fill it in, scan it, and send it back to you
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