Daily Attendance at Golden Elementary

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Please fill out this form for each student that will be absent. Thank you!

Email *

Date of Absence *

YYYY

STUDENT'S Last Name *

STUDENT'S First Name *

Parent or Guardian's Name *

Parent Phone Number *

Reason for the Absence *

Symptoms - If you checked Illness above, please select symptoms that apply. Please note a Health Clerk may contact you for more information. If you have another reason for the absence, please check the first box only. *

My student is not absent due to illness

Fever

Congestion or runny nose

Sore throat

Nausea, Vomiting, Diarrhea

Headache

Fatigue

Muscle or body aches

Cough

Difficulty breathing

My child has tested positive for COVID-19

Other

Required

Use this space to add any information that you would like the office to have

Teacher Name *

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