Arlington Absence Verification Questionnaire

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This form has been updated 1/10/2024.

Email *

Student's First Name (One student per entry) *

Student's Last Name *

Your Full Name. *

Best phone number to reach you. *

What is the date(s) of absence? *

YYYY

Teacher's Name *

Eguchi (Rm. 1)

Gordon (Rm. 2)

Sanders (Rm. 3)

Orquiola (Rm. 4)

Fukunaga (Rm. 10)

Hampikian (Rm. 12)

Skow (Rm. 13)

Parker (Rm. 14)

Haney (Rm. 15)

Shintaku (Rm. 16)

Kuriyama (Rm. 17)

Kennedy (Rm. 18)

MacLean (Rm. 19)

Gerhardt (Rm. 20)

Lee (Rm. 21)

Camberos-Hinds (Rm. 22)

Christie (Rm. 23)

Nakano (Rm. 26)

Suh (Rm. 27)

Biesman-Simons (Rm. 28)

Nazarian (Rm. 30)

Hargenrater (Rm. 31)

Hatai (Rm. 32)

Rosales (Rm. 33)

Reason for absence (check all that apply). : *

Fever ( fever 100.4+ must go away overnight and be gone in the morning without the use of Tylenol, Motrin, or Advil before returning)

If flu (confirmed or suspected) your child should isolate until 48 hours after symptoms resolve. Symptoms include nausea, vomiting, diarrhea, abdominal pain, headache, and low-grade fever lasting about 24-48 hours.

Cough/Runny Nose

Injury

Medical appointment (Please have student bring doctor's note upon return). Consider coming for partial day.

Funeral of immediate family member

Vomiting (2 or more times in 24 hours).

Sore throat (if mild, okay to attend school with mask)

Diarrhea (keep home if your child is unlikely to make it to the toilet in time)

Respiratory Virus Symptoms with fever (cough, stuffy / runny nose with fever) Can return after fever free 24 hours no meds.

Other:

Required

If your child has tested positive for coivid - list symptom start date. Please follow the Covid-19 Isolation Guidance: https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/COVID-19/COVID-19-Isolation-Guidance.aspx
*

Upload COVID results here https://forms.gle/GvvL77Kr2FooxgMw9

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