Family Self-Reporting
Please use this form to self-report symptoms, positive cases of Covid-19 or required quarantine.  
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Student's First Name *
Student's Last Name *
Student's School *
Student's Grade *
Please select the option that best describes the situation: *
If you selected other for the previous question, please explain
Please select symptoms from the list below: *
Who is completing this form? *
Best phone number and time of day to be reached by district nurse.   *
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