This form is no longer in use. Please contact the school.
Parents/Guardians - Please use this form to document student positive COVID19 cases from November 24th at 4pm through November 30th at 8am. Positive cases before this time or after this time should be reported to the school nurse or office. Positive cases will likely be contact traced beginning Monday November 30th.
Email address *
Student First and Last Name
Parent/Guardian Name
Parent/Guardian Phone Number
School Building
Student's grade level
Date the student was last at school
MM
/
DD
/
YYYY
Positive test date
MM
/
DD
/
YYYY
Date of onset of symptoms
MM
/
DD
/
YYYY
Please list any school activities in which the student is involved
Is the student a bus rider?
Clear selection
If yes, date of last time on bus.
MM
/
DD
/
YYYY
Does the student attend STRIPES?
Clear selection
If yes, date of last attendance.
MM
/
DD
/
YYYY
If yes, time of last day of attendance.
Time
:
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of Republic School District. Report Abuse