Travel and Contact Reporting Form
Email address *
Name *
Child's Name
Child's Grade
If someone in your household has traveled to a country outside of the United States in the past month, what country was visited?
If anyone in your household has visited or plans to visit another state, what city and state was or will be visited?
Has anyone in your household had an illness in the past two weeks? *
Any other information we should be aware of:
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