Riviera Elementary Absence Verification Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Email *

Student's First Name *

Student's Last Name *

Grade Level *

Teacher *

Parent/Guardian Name (First and Last Name) *

Date of Absence - Beginning Date *

YYYY

Date of Absence - End Date *

YYYY

My child is not at school because (please check all that apply) *

Fever of 100.4 or greater (student must be 24 hours fever free before returning to school)

A New Cough

Vomiting (student must be 24 hours fever free before returning to school)

Diarrhea (student must be 24 hours fever free before returning to school)

Quarantining

Medical or Court Appointment (please provide a note)

Bereavement

Religious

Other (please be specific and enter your reason below)

Other:

Required

A copy of your responses will be emailed to the address you provided.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

This form was created inside of Torrance Unified School District. Report Abuse