1. First and last name of High School student who will be absent. *
Your answer
2. Name of the person filling in this form and your relationship to the student. *
Your answer
3. Grade of Student *
Choose
Grade 9
Grade 10
Grade 11
Grade 12
4. Please provide the phone number we can call if we have any questions. *
Your answer
5. Date(s) that your student will be absent. *
Your answer
6. What is the reason for the absence? *
Your answer
7. Is your student arriving to school late or leaving early?
Clear selection
8. If your student is arriving to school late/leaving early, please let us know the time and reason.
Your answer
9. If your child is ill, what are the symptoms?
Your answer
10. If your child is ill, do you have any confirmed diagnosis from a doctor? Please list diagnosis (Strep Throat, Influenza A, RSV, COVID, ear infection, etc.)
Your answer
11. Anything else you want us to know?
Your answer
12. Do you want someone from the office to give you a phone call to follow up? (Please be sure to include a contact number in question #4 above)
Clear selection
A copy of your responses will be emailed to the address you provided.