COVID Reporting Form | South County High School

Student's First Name

Student's Last Name

When did students begin to have symptoms of COVID-19? If asymptomatic type N/A.

What was the date the test was taken ?

What was the date the test results were received ?

Type of Test if known (e.g. Rapid, PCR)

When was your student last on campus?

Did your student visit any other FCPS sites or locations? If so list the location and dates visited.

Does your student take a school bus to and from school?

Yes

Is your student involved in any sports, activities or clubs at South County high school? List the activity and dates attended.

Who does your student deem as a potential close contact? List first & last names if known (Potential close contact: students closer to the positive case than 6 feet if UNMASKED or 3 feet if MASKED for 15 minutes or more within a day)

Student Grade Level

Parent/Guardian Contact Information

Phone Number

Alternative Phone Number

Parent/Guardian Email Address

By submitting this form, you are confirming that you are the parent or legal guardian of the student

A form submission receipt will be sent to the email address that you provide on this form.

Email us with COVID reporting questions at [email protected].