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GCPS Student Required Absence Note
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Name of Student
Your answer
Teacher
Your answer
Parent/Guardian name
Your answer
Parent/Guardian phone number
Your answer
In the last 14 days, has your child experienced or currently experiencing any of the following symptoms?
none
fever of 100.4 degree or higher
difficulty breathing
persistent cough
new onset of loss of taste or smell
Is your child experiencing any of the following symptoms that he/she does not normally experience?
none
fatigue
congestion or runny nose
muscle or body aches
headache
sore throat
nausea, vomiting or diarrhea
Date that symptoms started
MM
/
DD
/
YYYY
Has your child had any known COVID contacts in the last 14 days?
Yes
No
Maybe
Clear selection
Date of known exposure
MM
/
DD
/
YYYY
Has your child been tested for Covid since symptom onset?
Yes
No
Clear selection
Date of Covid test
MM
/
DD
/
YYYY
Covid test results
Positive
Negative
Pending
My child has not been tested
Clear selection
Has your child been seen by a doctor and given an alternative diagnosis?
Yes
No
Clear selection
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