COVID EXPOSURE NOTIFICATION

COVID EXPOSURE NOTIFICATION
This form is to help us communicate about positive covid cases in our programs and to assist us in contact tracing and exposure notifications for our families.

None of the fields are required, but we strongly encourage you to respond to all the questions.

Thank you.
Student name

First Name Last Name
What program is {studentName3} attending ?
When did the student test positive ?

Month Day Year
Date
What test did you use ?
What symptoms does {studentName3} have/had ?
If any, when did the symptoms start?

Month Day Year
Date
What is your child's vaccination status ?
When was the last time your child attended our programs ?

Month Day Year
Date
Should be Empty: