Glenknoll Elementary Absence Form

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Email *

Date of Absence *

YYYY

Student Name *

Parent/Guardian Name *

Relationship to Student *

Absence Duration *

All Day Absence

Arriving Late

Reason for the Absence *

Other Reason for Absence (If Not Listed Above)

Symptoms (If Applicable)

Fever Above 100.4°F

Chills

Cough

Shortness of Breath or Difficulty Breathing

Fatigue

Muscle or Body Aches

Headache

New Loss of Taste or Smell

Sore Throat

Congestion or Runny Nose

Nausea or Vomiting

Diarrhea

Tested Positive for COVID-19

Been in Contact w/ Someone Diagnosed w/ COVID-19 in Past 14 Days

Other:

Teacher Name *

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

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