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Travel Notification Form

Welch Public Schools

For PDF version, click here.

 

 

 

Name(s) of those traveling (First, Last): *

Student:________________ Parent of Student: ___________________  Employee:_______________

 


Contact Information

Phone * (      )

Email:_________________________

 

 

Please identify an emergency contact (Name, Relationship, Phone): 

_______________________________
_______________________________
_______________________________

 

Travel Information
 

Are you planning on traveling outside the state of Oklahoma during spring break? 

 ○ Yes 

 ○ No

Are you planning on traveling outside the United States during spring break? 

 ○ Yes 

 ○ No

 

What city and state are you planning to travel to over spring break:

 

____________________________________________________

 

Where are you currently traveling or planning to travel? If other, please specify the location outside the United States. *

   □ Mainland China

   □ Iran

   □ Italy

   □ South Korea

   □ Japan

   □ Other (including a cruise): 

 

 

 

Please describe your travel plans. Include U.S. departure and U.S. arrival dates and locations visited (city/country). *

 

 

 

 

Are you aware that you must self-quarantine for 14 days prior to returning to school or work if you have traveled to China, Iran, Italy, South Korea, Japan or any other country or state determined to be a Level 2 or Level 3 by the CDC? *

 ○ Yes 

 ○ No