Date of first student absence related to COVID (Type NA if student has not missed school yet). *
MM
/
DD
/
YYYY
Student Last Name, First Name *
Your answer
Student ID without the "S" (also known as Lunch ID) *
Your answer
Grade *
Choose
EE
PK
Kinder
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Graduate - Reddix only
Is the student involved in Extra Curricular Activities? If so please list, if not please type NA *
Your answer
Parent/Guardian's Name and Relationship to student: Last Name, First Name, Relationship (Mother, Father, Grandparent, Guardian, etc) *
Your answer
Phone Number *
Your answer
Email *
Your answer
Has your student had a known exposure to COVID 19 in the last 2 weeks? Type Yes or No. If yes please include the date of last exposure *
Your answer
What type of exposure was your student exposed to? *
Symptoms: *
Please select any and all symptoms the student may be having. If student is not having symptoms select None.
Required
Start Date for Symptoms (Please type NA if student does not have symptoms.) *
Your answer
Last Date on Campus or at NISD Event *
MM
/
DD
/
YYYY
Vaccinated Status: *
Name of Vaccine: *
If not vaccinated select NA
Required
Date of last dose of vaccine *
If not vaccinated enter NA
Your answer
COVID Test Date (Type NA if you have not been tested) *
Your answer
COVID TEST Results *
Type of COVID Test *
I know and understand that I need to email all test results to the Campus Nurse, Jenifer Rasti @ jenifer.rasti@nisd.net *
I know and understand that I need to email all doctor's notes and medical documentation for this case to the Campus Nurse, Jenifer Rasti @ jenifer.rasti@nisd.net AND attendance secretary, Melinda Zaragosa @ melinda.zaragosa@nisd.net *
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