COVID-19 Report_Parent Submittal
Date
-
Month
-
Day
Year
Date
Principal
Campus
Person Completing Form
*
Last Name
First Name
Title
Student Name
Student ID Number
*
Street Address
*
City
*
County
State
Zip
*
Student Date of Birth
*
Parent/Guardian Cell Phone
*
2nd Phone
Parent Email Address
Student Gender
*
Hispanic or Latino/a
*
Yes
No
Symptoms
*
Fever>100
Chills
Muscle Aches
Runny Nose
Sore Throat
Loss of Smell
Loss of Taste
Headache
Fatigue
Cough
Wheezing
Shortness of Breath
Chest Pain
Nausea or Vomiting
Diarrhea
None/Does Not Apply
Back
Next
Quarantine Start Date (The start date is the day after symptoms onset. )
*
-
Month
-
Day
Year
Date
Quarantine End Date (5 days after the start date.)
*
-
Month
-
Day
Year
Date
Return to School/Work Date (The day after the Quarantine End Date that you just entered.)
*
-
Month
-
Day
Year
Date
Vaccinated for COVID
*
Phizer
Moderna
J & J
One Dose
Boosted
Not Vaccinated
COVID Status
*
Confirmed
Presumed Positive
Symptomatic
Asymptomatic
Today's Date
-
Month
-
Day
Year
Date
List 5 people they spent the most time with and/or eat lunch with while on campus.
If you have a copy of the student's COVID test results, please upload it here. If you have not tested yet, or are awaiting results, please revisit our website's homepage and submit those one you receive them.
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