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Reporting Form: Positive Covid Individual

Please complete the form below. Required fields marked with an asterisk *

Student First Name*

Answer Required

Student Last Name*

Answer Required

Student's Homeroom Teacher *

Answer Required

Parent/Guardian Reporting*

Answer Required

Is this child vaccinated?*

Answer Required

Yes, completed all required shots and final shot was more than 2 weeks ago, but less than 6 months ago

Yes, completed all required shots and final shot was more than 2 weeks ago, but more than 6 months ago

Partially, only received 1 of 2 shots or has not been 2 weeks since final shot

If you have not yet submitted your child's vaccination card, please do so here.

Answer Required

Choose a file or drag it here.

Parent/Guardian Email*

Answer Required

Does this child have symptoms?*

Answer Required

Yes

Please list date symptoms began

Answer Required

Testing Date*

Answer Required

Does your child play on a CK sports team?*

Answer Required

Yes

What was the last day your child played or practiced with a CK team?

Answer Required

Has your child been in close contact with other CK students in the past 48 hours? This applies to contact in the 48 hours prior to him/her developing symptoms (if symptomatic), OR 48 hours prior to their positive test (if asymptomatic). Please consider carpools, playdates, after-school game club, etc. *

Please list the CK student's name and the date they were last with your child.

Answer Required

Is anyone else within your household Covid positive? If so, please list.*

Answer Required

Is anyone else within your household displaying symptoms? If so, please describe.*

Answer Required

If you have other CK students, please complete this Close Exposure form. https://school.ckchicago.org/apps/form/form.CHRTKSS.sifLzYw.1yb?_=1607132551148

Hope your loved one is better soon!

Confirmation Email

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