Family COVID-19 Case Report
The purpose of this form is to determine the course of action based on a student's potential exposure to COVID-19.  

A Confirmed Case is a situation in which you know that a student has been tested for COVID-19 and received a positive result.

Close Contact is defined as any of the following:  1). A student living with a person who has a confirmed case of COVID-19, 2). a student being within 6-ft of a person with a confirmed case of COVID for more than 15-minutes.  
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School *
Name of the person filling out the form *
Name of student involved. *
Contact phone number *
Contact email *
Select your situation *
Has the student listed received one or more doses of a Covid 19 vaccine? *
Please give the date when symptoms began or when your child had the last contact with the positive person. *
Did a medical provider or health department give you a return to school date? (If not, it is a 5 day quarantine from first day of symptoms or positive test if no symptoms.) *
Do you know where your child contracted COVID-19? (If you are not confident, mark unknown) *
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