Notification of COVID-19 Exposure

Parents and staff are urged to fill out this form as soon as they become aware of an exposure or a positive test result for themselves or a close contact - even after hours or at night. This information will be immediately sent to the nursing staff and administrators so that steps can be taken to protect other students and staff. Please be in touch with the nurse to determine when you can come back to school.

Names of Affected Students or Staff Member:
Divisions: Please check all that apply: *
Covid-19 Information
Select those that apply
1. The person(s) listed above tested positive for COVID-19*
2. The person(s) listed above has been exposed to someone that tested positive for COVID-19 or someone that is presumed to have COVID-19: *
3. The person(s) listed above is under investigation for COVID19. *
4. The person(s) listed above has a household member(s) who is/are under investigation for COVID19. *
5. Have you attended a Simcha without being both masked and social-distanced? *
6. Do you plan to attend a Simcha without being both masked and social-distanced?
Parent Contact Information
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