Exposure to Contagious Disease Form

Notice of Exposure to Contagious Disease Form:

Date: / /

Dear Legal Guardian:

A child in (business) has or is suspected of having:

Information about this disease-

The disease is spread by:

The symptoms are:

The disease can be prevented by:

What (business) is doing to reduce the spread:

What you can do at home to reduce the spread:

If your child has any symptoms of this disease, call your healthcare provider to find out what to do and be sure to tell them about this notice. If you do not have a regular healthcare provider to care for your child, contact your local health department for instructions on how to find one, or ask (business) for a referral. If you have any questions, please contact:

Contact:                                                            Phone: