Summit Student Absence Form

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This form should be completed for each day you experience illness/symptoms and should be filled out every day until you return to school. Any time you miss school for any reason, you should also complete this form. We will no longer excuse absences for any reason unless this form is completed. Five unexcused absences (times being absent and not completing this form) will mean you must attend a mandatory attendance intervention in order to have access to all of your classes.

Email *

Full Name (First and Last) *

Phone number where you can be reached. *

Crew leader's name *

Have you talked to your crew leader today? *

Yes

If you are experiencing illness or symptoms today? If so please check all that apply below. *

No symptoms

Persistent cough

Fever

Shortness of breath

Difficulty breathing

New loss of taste or smell

Fatigue

Muscle aches

Headache

Sore throat

Nausea/vomitting

Diarrhea

Runny nose/Nasal congestion

Required

If you are having symptoms, when did they start?

YYYY

If you will be missing your assigned session for some other reason, please tell us what the reason is here.

Have you been tested for COVID-19 due to your current symptoms? *

Yes

Will you be attending Journeys today? *

Yes

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