Bristol Public Schools: Launching into Healthy Learning 8/22
This form is to be completed by BPS parents or guardians of a student, or an employee to report positive COVID -19 status. 
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Email *
In the space below type your child's first name. If an employee, type your first name. *
In the space below type your child's last name. If an employee, type your last name.   *
In the space below, enter your child's date of birth. If you are an employee, enter your date  of birth (month/day/year).
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Enter your child's grade level. 
I am completing this form as: *
Todays date is: *
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My child tested positive for COVID-19 on (enter date of test). If you are an employee, enter the date of the positive COVID-19 test result: *
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Enter the date of onset of COVID symptoms (if symptomatic).
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Select the appropriate response regarding symptomology below: *
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I can be reached by phone at:
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