This form is designed to allow parents and guardians to inform the school of a positive COVID-19 test.

A close contact is someone who has had close interaction with a person with COVID-19 during their infectious period.

– Lives in the same house as you
– Is an intimate partner
– Is directed by WA Health that they are a close contact
– You spent 2 hours+ in a small room where masks have been removed
– 15 mins+ interaction where you were both not wearing a mask

Parents/Guardian name(Required)
Student name(Required)
Date of birth(Required)
DD slash MM slash YYYY
DD slash MM slash YYYY
DD slash MM slash YYYY
Has WA Health been in contact?
Please share the full name of students your child deems as close contact, as defined above.