YMCA Confirmed COVID Reporting
Please fill out this form to report a confirmed covid case.  If reporting more than one case please fill out multiple forms.  
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Email *
Child's Name *
Program *
If School Age Childcare-School Name
Last date child was present in the Y program *
MM
/
DD
/
YYYY
Date symptoms started (if applicable)
MM
/
DD
/
YYYY
Date positive test was taken *
MM
/
DD
/
YYYY
Reporters Name *
Reporters Contact Phone *
Submit
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