COVID-19 Case Report Form
HLWW wants to keep our students and staff safe. If you have you learned of a positive Covid-19 case or exposure for your child or if you have symptoms or are positive, please fill out this simple CONFIDENTIAL form. One of our trained staff will contact you regarding protocols, next steps and when you (if staff) or student are able to return to school. *Required answers
Who has the positive Covid-19 test result or is experiencing symptoms?
First and Last Name of the Person with positive Covid-19 test or is symptomatic?*
Name (First and Last) of the Person Reporting for the Student
What is the best phone number to reach you for follow up or further information?
What School or Building are you or your student at?
HLWW Middle School
HLWW High School
Do you have other children or family members at HLWW? Please list names and/or grades:
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This form was created inside of Howard Lake - Waverly - Winsted School District.