COVID-19 Case Reporting

If your child has tested positive for COVID-19 or has come into contact with someone who is, or may be, positive, please complete and submit the following form immediately. One form per child, please.

Parent/Guardian Name*
First Last
Email Address*
Phone*
Child Name*
First Last
Which center does your child attend?*
Has your child tested positive, or has he/she been exposed to COVID?*
- My child has tested positive for COVID
- My child has been exposed to an individual who has tested positive for COVID
If exposed, is the positive individual a member of your household?*
- Yes
- No
- N/A
Date of positive COVID-19 test OR exposure to someone with a positive case?*
MM slash DD slash YYYY
Is your child experiencing COVID-19 symptoms?*
When did your child's symptoms begin?*
MM slash DD slash YYYY
When was your child last in the center?*
MM slash DD slash YYYY
Have you been contacted by the PA Department of Health?*
Please provide additional details or comments...
Comments
This field is for validation purposes and should be left unchanged.