Covid Symptom Reporting Form
If your child is experiencing any symptoms of Covid-19, you can use this form to communicate and ask questions as well as inform us if your child needs to quarantine or has tested positive. This information will be reviewed by office staff as well as a medical professional from Wellspring. We are partnering with Wellspring, our local medical and counseling clinic, to assist with contact tracing and helping families dealing with Covid. A friendly reminder that symptoms may include fever, shortness of breath, a new or worsening cough, loss of taste or smell, or any other symptoms of a cold or the flu.
Child's LAST name
Childs FIRST name
Child's Birthdate
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DD
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YYYY
Child's grade
Parent Name
Parent phone
Parent email
Description of the symptom or question
Date of exposure to Covid-19 (if known)
MM
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DD
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YYYY
Date of the first symptom
MM
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DD
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YYYY
Submit
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