2022-2023 Student Absence Reporting Form

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Please fill out this form if your child will be absent from school. Absences are classified as excused or unexcused. Please refer to the St. Joseph School handbook for definitions on unexcused or excused absences.

If it is outside of the school day or the weekend and you know that your child will be absent, please complete this form. If it is during the school day and you suspect that your child has COVID-19 or has been confirmed of having COVID-19, please call our school at 651-423-1658.

This questionnaire asks about student health, symptoms, and potential exposure to COVID-19. The data collected may be classified as private under the MN Government Data Practices Act. The data you share may be used for the following purposes:

1.) To screen for potential COVID-19 related symptoms and exposure in an effort to avoid the spread of COVID-19;
2.) To determine when it is safe for the student to return to school;
3.) If the student has tested positive for COVID-19, the information shared may also be used to notify other individuals who may have been exposed to COVID-19 through their contact with the student. If this is the case, the student's name will not be used with these individuals.

You are not legally required to provide this data. However, if you decline to provide the information requested, the student may not be admitted into the school.

Data collected may be shared with school administration, and other persons or entities authorized by law, including public health authorities. De-identified data may also be used with individuals who may have been exposed to COVID-19 through their contact with the student.

PLEASE FILL OUT A SEPARATE FORM FOR EACH CHILD. THANK YOU!

Email *

Student name and grade: *

Student date of birth *

YYYY

Parent/Guardian names and phone numbers *

My child has the following symptoms: *

Fever (≥ 100.0°F or higher) and chills

Cough (new cough or cough gets worse)

Sore throat

Shortness of breath or trouble breathing

Excessive fatigue (being very tired)

Nausea/Vomiting

Diarrhea

Nasal congestion or runny nose

Muscle/body aches

Loss of taste or smell

Headache

Rash

Other symptoms not listed above (please list below)

My child is not sick, he/she is not sick but will not be in school (please list reason below).

Required

Please list any symptoms your child has that are not listed in previous question.

My child is not sick. Please list the reason that he/she will be absent from school.

Symptoms first appeared on what day? (please list month, day, year). Or write none if not ill. *

Please list any additional family members that attend St. Joseph School. *

Does your child attend the St. Joseph School ESC (Extended School Care) program? *

Yes

Does your child currently participate in extra-curricular activities St. Joseph School? *

Yes

Is there any additional information you would like to share with us at this time?

Submit

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