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Field Attendance
INSTRUCTIONS: Please complete a form for EACH student in your household who is absent. Please complete a form for each separate student illness.
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* Indicates required question
Student Name
*
Your answer
Student ID (if known)
Your answer
Today's Date
MM
/
DD
/
YYYY
Which school does your student attend?
*
Choose
Arapahoe High School
Centennial Academy of Fine Arts Education
East Elementary
Euclid Middle School
Field Elementary
Franklin Elementary
Goddard Middle School
Heritage High School
Highland Elementary
Hopkins Elementary
Lenski Elementary
Littleton High School
Newton Middle School
Options Secondary
Peabody Elementary
Powell Middle School
Ralph Moody Elementary
Runyon Elementary
Sandburg Elementary
Transition Services
Twain Elementary
Voyager
Wilder Elementary
Village at Highland
Village North
Nova North
Nova Newton
What grade?
*
Choose
Preschool
Kindergarten
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Date of Birth
*
MM
/
DD
/
YYYY
What are your student’s symptoms that caused his/her absence today? Check ALL that apply .
*
Fever of 100.4 or higher
Sore throat
Cough
Shortness of breath
Body aches/chills
Fatigue
Congestion
Headache
Asthma related symptoms
Nausea
Diarrhea
Vomiting
Rash
Mental health related concern
Exposure to a person suspected/ positive for COVID-19
Other illness/injury
Other (appointment, vacation, family, etc)
Required
If you selected other illness/injury, please describe here:
Your answer
If your student is out ill, please share when the symptoms first began?
MM
/
DD
/
YYYY
If your student is out ill, have you isolated them?
Under health care provider or health department orders
Self isolation due to symptoms and possible exposure to COVID-19
Self isolation due to exposure to a potential positive COVID-19 case
Not isolated
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