Covid Intake Form-(Positive Cases of Covid-19)
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Email *
Class *
First Name of Student or Staff Member *
Last Name of Student or Staff Member *
Date of Symptoms (if applicable)
MM
/
DD
/
YYYY
Date of COVID-19 Test: *
MM
/
DD
/
YYYY
Test Type *
Last day in the school building *
MM
/
DD
/
YYYY
OSIS# for Student OR Employee ID/Reference # for Staff
Does the student attend after school?
Clear selection
Does the child have a sibling(s)?
Clear selection
If yes, are they vaccinated?
Clear selection
If yes, do you know the sibling's name and class?
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