eSchool Student Absence Report

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Please fill form out completely. If you have questions, contact lesley.schradle@rfsd.k12.wi.us Thank you!

Student Name and Grade: *

Parent/Guardian Name: *

Staff will follow up with family to verify the absence.

Student's Teacher: *

Date of absence: *

YYYY

Reason for absence: *

Illness

Appointment (verification required)

Parent Excused

Other

Please add detailed info if you chose "appointment" or "parent excused" above. (put N/A if you chose illness above) *

Which symptoms has your child exhibited?Check all that apply. (*=one of these means child must stay home - siblings may attend if no symptoms showing; **=If any one of these symptoms last for 24 hours or more, child must be seen by a Dr. and/or get COVID test, & must be symptom free for 24 hours before returning to school.)

Persistent Cough *

Shortness of Breath*

Difficulty Breathing*

New Loss of Taste or Smell*

Sore Throat*

Congestion/Runny Nose

Muscle Pain/Aches

Diarrhea**

Nausea/Vomitting**

Fatigue

Headache*

Fever over 100.4' (without medication)*

Other:

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