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Covid Positive Test or Close Contact Form: Tri-Valley
Please fill out this form if you are a confirmed positive case of Covid-19 or have been named as a close contact in need of quarantine.  Please also e-mail our nurses to keep them informed and to help the school contract trace and provide assistance.  Please fill out a separate form for each Tri-Valley student involved.

In addition, there are new and shortened quarantine requirements listed here https://drive.google.com/file/d/1aBh-usjZmPggjY1Su0iWdz82opimtyMH/view?usp=sharing.

Angela McCrary (ES):  amccrary@tri-valley3.org
Sarah Conroy (MS and HS):  sconroy@tri-valley3.org


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Name of Tri-Valley Student *
Grade level of Tri-Valley Student *
If the student is in pre-k-6, please indicate the name of the child's teacher.
Has the student tested positive for Covid 19? *
If answer was yes, please indicate the date of the positive test.
If the student is positive, please indicate any "close contacts" at Tri-Valley by name and grade level.  (A close contact is a person that has been within 6 feet of the individual for 15 minutes).  Please call any known close contacts.  
Has the student been considered a close contact of someone that tested positive for Covid 19. *
If the answer was yes, please indicate the date of last contact with the infected individual
If yes, what is the relationship of the infected person and close contact (ex. family member, friend, etc)
If the child is experiencing any symptoms, please describe.
If symptomatic, when did symptoms begin? (Provide date).
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IDPParent Name *
Parent e-mail *
Parent Phone number *
Any additional information that you would like to share.
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This form was created inside of Tri-Valley Community Unit School District #3.

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