COVID REENTRY FORM

If you were out with COVID-19, you must complete this form attesting that you have completed the necessary steps to return. By submitting this form, you attest that all the information you have provided is true and accurate. Parent(s)/guardian(s) may complete this form on behalf of their child. Please note: Submissions to this form are completely confidential and only shared with the school nurse's office and administration. DO NOT RETURN to school until receipt of this form has been confirmed by the nurse or school administration.
Student or Faculty/Staff*
- Student
- Faculty/Staff
Name*
First Last
Student Grade*
Date of Birth*
MM slash DD slash YYYY
Parent/Guardian Name*
First Last
Best Phone Number*
Email*
Dates of Absence*
Additional comments/information: