COVID-19 Release
If you or someone in your household has tested positive for COVID-19 or has been exposed to COVID-19 please complete the following exposure notification form. Your participation helps keep our whole community safe.
Today's Date
/
Month
/
Day
Year
Child's Name
First Name
Last Name
Name of Individual Reporting
*
First Name
Last Name
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Date of Exposure
-
Month
-
Day
Year
Date
Submit
Should be Empty: