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2023-24 LP Student Absence Reporting Form
Please complete this form to report your student's
full or partial day absence
for the 2023-24 School Year.
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* Indicates required question
STUDENT LAST Name
*
Your answer
STUDENT FIRST Name
*
Your answer
Date of absence
*
MM
/
DD
/
YYYY
ADULT'S Full Name reporting absence (Parent/Guardian)
*
Your answer
Adult's contact phone number or email address
*
Your answer
Reason for absence
*
Fever (temperature of >100F when taken by mouth)
Sore Throat
Cough, Muscle or body aches
Congestion or runny nose
Asthma-induced/related shortness of breath/difficulty breathing
Flu A Positive
Flu B Positive
Covid Positive
Headache
Nausea/Vomiting or Diarrhea within the last 24 hours
Pink Eye/Conjunctivitis
Injury to student (outside or inside of school)
Death in the immediate family
Pre-Planned Absence (In order for absence to be excused, parent MUST send an email approval request to
attendance@lutzprep.org
3 days prior to absence.)
Appointment: Will be arriving late to school with note
Other
If checked "other" above, and if NOT Covid or health related, please list reason for absence below. If not applicable, type N/A below.
Your answer
COVID POSTIVE: Please list symptoms start date and type of test taken below.
Your answer
Please forward any appropriate or necessary documentation regarding your student’s attendance to
attendance@lutzprep.org
.
CONFIDENTIALITY NOTICE: This electronic information is for the sole use of the intended recipient(s) and may contain confidential and privileged information. Any unauthorized review, use, disclosure, or distribution is prohibited.
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