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Covid Parent Reporting Form
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* Indicates required question
School your student attends
*
Decatur Central High School
DTSE
Decatur Middle School
Liberty
Blue
Gold
West Newton
Valley Mills
Stephen Decatur
High Ability Academy
Student's First Name
*
Your answer
Student's Last Name
*
Your answer
What grade is your student in?
*
Your answer
Student date of birth
*
MM
/
DD
/
YYYY
First name of person reporting
*
Your answer
Last Name of person reporting
*
Your answer
Relationship to student
*
Your answer
Phone number to be reached at
*
Your answer
Which are you reporting?
*
My student is sick.
My student is a close contact to someone living in our home * At school, masks continue to be worn, therefore students who are a close contact do not need to quarantine if showing no symptoms.
Other:
If your student has any symptoms, please list them. You can say "No Symptoms" if that fits.
*
Your answer
Has your student received a positive test result or diagnosis?
*
Yes
No
No test taken
If your student is positive, choose which applies.
*
At home test
Lab
Doctor's Office
Student has not tested positive
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