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MHS Student COVID Reporting
This form is for Montgomery High School students only.
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Student Name (as it appears on school records):
Your answer
Student address, city, zip:
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Student Date of Birth:
MM
/
DD
/
YYYY
Student's School ID Number:
Your answer
Student's Grade:
9
10
11
12
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For which reason are you completing this report?
EXPOSURE: My child is staying home due to exposure or close contact to COVID-19.
POSITIVE: My child has tested positive for COVID-19 (any form of testing is acceptable).
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