SMS PK-8th Grade COVID reporting

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Please complete and submit this form if your child has tested positive for COVID. You will be notified of the appropriate guidelines after the form is reviewed by the School Nurse.

Please read this form carefully. Fill out all fields as they apply to your family.

Please fill out one form for each child.

Preferred Email *

Parent/Guardian Name *

Student Last Name *

Student First Name *

Student Grade *

Students Last Date of Attendance *

YYYY

Is Student Fully Vaccinated? *

COVID Vaccination Card *

Reporting a Positive Result: When did Symptoms Start? (If No Symptoms, Use Date of Positive Test)

YYYY

Date of POSITIVE COVID Test

YYYY

Type of COVID Test *

Send Test Results

COVID Symptoms (Select All That Apply) *

Fever, please add highest temperature under "Other"

Chills

Muscle/Body Aches

Headache

Sore Throat

Nausea/Vomiting

Diarrhea

Fatigue

Congestion/Runny Nose

Cough

Shortness of Breath

Difficulty Breathing

Loss of Taste

Loss of Smell

No Symptoms

Other:

Required

Any Other Information You Would Like to Provide to the School Nurse.

Submit

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