Positive COVID Student Report
Please complete this form if your child attends Calhoun City Schools and has tested positive for COVID-19 beginning 12/18/20 through 1/6/21. Someone will be in contact with you prior to January 6.
* Required
Email address
*
Your email
Student's First and Last Name
*
Your answer
Student Grade
*
Your answer
Student's Address
*
Your answer
Date COVID Related Symptoms Started
*
MM
/
DD
/
YYYY
Date Student Tested Positive for COVID
*
MM
/
DD
/
YYYY
COVID Testing Location
*
Your answer
Does Student currently participate in any school extracurricular activities?
Your answer
If possible, please list any other students or staff your child feels like has been a close contact (within 6 feet for more than 15 minutes) since 2 days before his/her symptoms started. *If you are able to notify any of your close contacts, please feel free to do that.
*
Your answer
Parent First and Last Name
*
Your answer
Parent Contact Number
*
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of Calhoun City Schools.
Report Abuse
Forms
