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COVID-19 Reporting Form

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It is critical that students, faculty, and staff who have been potentially exposed to or tested positive for COVID-19 complete the below form to ensure that we can continue to provide the safest on-campus learning environment possible. This information will also assist LCA in partnership with public health officials to monitor the incidence of cases occurring within the LCA community. We are committed to ensuring that your submission remains confidential in accordance with applicable laws and will only be used to provide to ensure those who have been exposed are contacted.
  • Please indicate why you are completing this form.
  • Please select one of the following.
  • Please read the following statements carefully. Then select any that apply.
  • Examples might include COVID-19 test results or physician documentation
  • Please provide your name, email, and phone number.
  • Please provide the name, grade, and date of birth for your student; a form will need to be submitted for each LCA student impacted.
  • Date Format: MM slash DD slash YYYY
  • Please indicate within which division you work.
  • Please select the date in which COVID-19 symptoms first started.
    Date Format: MM slash DD slash YYYY
  • non-COVID related could include season allergies, common cold, etc.
  • Date Format: MM slash DD slash YYYY
  • Please indicate the results of the test.
  • Please select the date in which student/staff was last on LCA's campus.
    Date Format: MM slash DD slash YYYY
  • Please enter the date of LCA student/staff's last known exposure to COVID+ household member. Exposure is defined as close contact of 6 feet or less for 15 minutes or more.
    Date Format: MM slash DD slash YYYY
  • LCA Persons of Close Contact

    Close Contact is defined as:

    • You were within 6 feet of someone who is COVID+ for a total of 15 minutes or more
    • You provided direct care at home to someone who is COVID+
    • You had direct physical contact with COVID+ person (hugged or kissed them)
    • You shared eating or drinking utensils with COVID+ personA COVID+ person sneezed, coughed, or somehow got respiratory droplets on you
  • Please list the names of any LCA student, faculty, or staff with whom you were in close contact starting from two days before illness onset or two days prior to date when your were tested (not when you received your results).
  • Please provide any additional information you believe will be helpful to our LCA Health Services team.
  • Students/staff requesting to return to campus must meet the following three requirements:

    1. Completed the required quarantine
    2. Be COVID-symptom free
    3. Be fever-free for 24-hours without the use of fever-reducing medicine.
  • Examples might include COVID-19 test results or physician documentation
    Drop files here or
  • Examples might include COVID-19 test results or physician documentation
  • By submitting this form, I agree to be contacted via email and phone by LCA Health Services concerning the information provided.
Legacy Christian Academy Private School in Frisco Texas

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Location

Legacy Christian Academy
5000 Academy Drive
Frisco, TX 75034
United States (US)
Phone: (469) 633-1330
Email: communications@legacyca.com

Office Hours

Monday8:00 AM - 4:00 PM
Tuesday8:00 AM - 4:00 PM
Wednesday8:00 AM - 4:00 PM
Thursday8:00 AM - 4:00 PM
Friday8:00 AM - 4:00 PM

* Summers 9:00 AM - 3:00 PM

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