COVID-19 STUDENT ILLNESS REPORT
The Ohio Department of Health has issued an order that requires all Ohio school districts to report confirmed cases of COVID-19.

Milford Exempted Village School District asks that parents notify the District, either by filling out this form or calling us if their child either is exhibiting symptoms of COVID-19, has been tested for COVID-19 or has received a positive COVID-19 test.

This secure form is submitted directly to District Nurse Patty Price for review. You will receive a follow-up phone call from our District within 24 hours.
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CHILD'S FIRST AND LAST NAME *
PARENT'S FIRST AND LAST NAME *
WHAT IS A GOOD PHONE NUMBER TO REACH YOU? *
HOME ADDRESS *
SCHOOL STUDENT ATTENDS *
Required
STUDENT GRADE *
Required
WHAT SYMPTOM(S) DOES YOUR CHILD HAVE? *
Required
HAS YOUR CHILD BEEN TESTED FOR COVID-19?
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HAS YOUR CHILD RECEIVED A POSITIVE COVID-19 TEST?
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WHAT DATE DID YOUR CHILD RECEIVE A COVID-19 TEST?
MM
/
DD
/
YYYY
WHAT DATE DID YOUR CHILD'S SYMPTOMS BEGIN?
MM
/
DD
/
YYYY
IF YOUR CHILD IS ILL, DO NOT SEND THEM TO SCHOOL.
Report your child's absence to your child's school. Absences must be reported prior to the start of the school day.
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