WCSD COVID-19 Reporting Form
The Wickliffe City School District is providing this reporting form to assist District staff in necessary contact tracing for potential exposure to COVID-19.

Please complete this form if you are the parent or guardian of a Wickliffe City School District student who has tested positive for COVID-19. The District will follow confidential reporting procedures in required reporting to health agencies.

Email *
Last name of the student who has tested positive for COVID-19. *
First name of the student who has tested positive for COVID-19. *
Grade level of the above-listed student. *
Date of first COVID symptoms
If asymptomatic (no symptoms) skip to the next question.
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Date of the positive COVID-19 test result. *
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Has your physician or the Lake County General Health District given you a return to school date for your child? If so, what is that date?
If no date was provided, skip to the next question.
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Name of the person completing this form. *
Relationship of the reporting adult to the above-named student. *
Phone Number of reporting adult *
Are there other Wickliffe Schools' students residing in your home? *
Household members will need to quarantine for 14 days from the first day of symptoms or the date of the positive test (if no symptoms). All students must be symptom-free before returning to school.
Does the above-named student participate in school-sponsored athletics, extra-curricular, or co-curricular groups (i.e. band, choir, and clubs)? *
Other information
Please provide any other information you feel is relevant about this student, illness, or situation.
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