East Attendance

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East Attendance

INSTRUCTIONS: Please complete a form for EACH student in your household who is absent. Please complete a form for each separate student illness.

Student Name *

Student ID (if known)

Today's Date

YYYY

Which school does your student attend? *

What grade? *

Date of Birth *

YYYY

What are your student’s symptoms that caused his/her absence today? Check ALL that apply . *

Fever of 100.4 or higher

Sore throat

Cough

Shortness of breath

Body aches/chills

Fatigue

Congestion

Headache

Asthma related symptoms

Nausea

Diarrhea

Vomiting

Rash

Mental health related concern

Exposure to a person suspected/ positive for COVID-19

Other illness/injury

Other (appointment, vacation, family, etc)

Required

If you selected other illness/injury, please describe here:

If your student is out ill, please share when the symptoms first began?

YYYY

Option 1

Clear selection

If your student is out ill, have you isolated them?

Under health care provider or health department orders

Self isolation due to symptoms and possible exposure to COVID-19

Self isolation due to exposure to a potential positive COVID-19 case

Not isolated

Submit

Clear form

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