COVID-19 Online Form Please fill in all fields and if a question is ‘Not Applicable’ write N/A Child's name(required) Child's surname(required) Child's date of birth (YYYY-MM-DD)(required) Child's classroom(required) Select your child's year level at school(required) Kindergarten Pre Primary Year 1 Year 2 Year 3 Year 4 Year 5 Year 6 Teacher's name(required) Reporter(required) Reporters relationship to child(required) Reporters contact number(required) Positive COVID test – RAT or PCR Select one (required) RAT PCR N/A Positive test date (YYYY-MM-DD) Asymptomatic or Symptomatic Select one (required) Asymptomatic Symptomatic Reporting close household contact Select one (required) YES NO N/A Date of close household contact (YYYY-MM-DD) Date returning to school (7 days after contact as long as asymptomatic) (YYYY-MM-DD)(required) Last date attended school (YYYY-MM-DD)(required) Additional comments SUBMIT FORM Δ
