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Absence Verification
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* Indicates required question
Enter Student's Name Below
*
Your answer
Date of Absence
*
MM
/
DD
/
YYYY
Relationship to Student
*
Mother
Father
Step-mother
Step-father
Other:
Required
Reason for Absence
*
Ill
Dr./Dentist(requires note from Dr. when student returns to school)
Funeral
Out of town
Other:
Required
Illness Symptom Checker- please complete if checked "Ill" above. Check all symptoms that apply. Students may not come back to school until 24 hours symptom free without medication. Please see the Keep Sick Children Home form on our website.
*
Fever above 100.4
chills
congestion or runny nose
cough
shortness of breath or difficulty breathing
nausea, vomiting, or diarrhea
fatigue
headache
sore throat
muscle or body aches
new loss of taste or smell
Rash
Red Eyes
Cracked/swollen lips
Swelling hands/feet
Stomach pain
None
Other:
Required
Electronic Signature
*
Your answer
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