COVID-19 Confirmed Case Form

Students Full Name* Students House* Year Group* Parent/Guardian Name* Parent/Guardian Email* Parent/Guardian Contact Number* Date of First Symptoms (if no symptoms, please select date of test)* Date of COVID Test* Date of Positive Test Result* Last date that the student attended school*

Does the student have any siblings at Fulston Manor?*YesNo

If yes, please provide the names and year groups of siblings below and complete the 'COVID-19 Self-Isolation Form' for each student that is self-isolating. How does the student travel to and from school?* If you have selected 'Public Transport' please provide as much detail as possible. For example which modes of transport and bus numbers or train times.

We now require two types of evidence in order to authorise student absence. Please therefore upload an image of the positive LFD test for your child and also a copy of confirmation that the test has been reported to the .Gov. website.

Please upload an image of your positive LFT here* No file chosen Please upload your confirmation of upload to .GOV website here* No file chosen

Fulston Manor School A Fulston Manor Academies Trust School

COVID-19 Confirmed Case Form

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