Student Absence Form

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Please complete this form to record an absence for your child. ONE STUDENT'S ABSENCE PER DAY, PER FORM. Always follow protocols for student illness as listed in Family Handbook or COVID-19 Response plan.

***Be sure to notify your child's teacher of the absence via email as well***

Absence Date *

YYYY

Student Name *

Parent Completing Form *

Student's Homeroom Teacher *

Reason for Absence *

Appt (unrelated to illness)

Fever (child may 𝙣𝙤𝙩 return until fever free with 𝗡𝗢 𝗳𝗲𝘃𝗲𝗿-𝗿𝗲𝗱𝘂𝗰𝗶𝗻𝗴 𝗺𝗲𝗱𝘀 𝗳𝗼𝗿 24 𝗵𝗼𝘂𝗿𝘀)

Feeling ill - determining symptoms

COVID symptoms - awaiting testing results

Positive for COVID (report to principal & teacher)

Travel (advance notification required)

Other:

If marked above "feeling ill" - please check symptoms. *

Does not apply

Fever (100.4 +)

Headache

Chills or Sweating

Aches/Myalgia or Fatigue

Sore Throat

Cough

Shortness of breath/Difficulty Breathing

Nasal/Sinus Congestion or Runny Nose

Chest Congestion

Vomiting

Nausea

Cramps

Other:

Required

Additional info?

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