LHCSD COVID-19 Reporting Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

LHCSD COVID-19 Reporting Form - Winter Recess

This form is for LHCSD parents/guardians to report COVID-19 positive cases over the Winter Break. A District Nurse will be monitoring this form and will contact any families who complete this form.

Este formulario es para los padres/guardianes del distrito escolar de la ciudad de La Habra para reportar casos positivos de COVID-19 durante el receso de invierno. Una enfermera del distrito estará monitoreando esta forma y contactará a cualquier familia que complete este formulario.

Student's Name / El Nombre del Estudiante *

Student's Date of Birth / Fecha de nacimiento del estudiante: *

YYYY

School / Escuela: *

Parent/Guardian Name/Nombre del Padre de Familia / Guardian * *

Parent/Guardian's Phone # /Número de teléfono del padre / tutor *

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of La Habra City School District. Report Abuse

Forms