Student/Household Member Travel Notification
We are requesting your cooperation in notifying La Pietra of all travel plans for students or members of their households outside of Hawaii for the remainder of March 2020 (subject to extension). This information will be kept confidential and any questions may be referred to Mrs. Gay Chinen, Dean of Students. We greatly appreciate your assistance in completing the form below.
Student's First Name
Your answer
Student's Last Name
Your answer
Parent's Name
Your answer
Parent's Cell Number (###-###-####)
Your answer
Parent's Email
Your answer
Student's Travel Plans
Please let us know of student's travel plans.
Start date of travel
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DD
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End date of travel
MM
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DD
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YYYY
Where did student travel to and from? List all countries, cities and states.
Your answer
Possible Contact with Confirmed Case
Report if there is possible contact with a confirmed case of COVID-19 infection or person under investigation for COVID-19. As recommended by the HDOH, person should NOT be allowed to attend school or work.
First known date of contact with person
MM
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DD
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YYYY
Other Possible Contacts
Report if there is possible contact with a family member or friend staying in your household who has traveled outside of Hawaii beginning March 10th. Please closely monitor your family household situation and if health situation changes, please notify us immediately and seek medical care.
First known date of contact with person
MM
/
DD
/
YYYY
Indicate where this person traveled
Your answer
Comments
Your answer
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