Email *
Parent/Guardian First Name *
Parent/Guardian Last Name *
Student First Name *
Student Last Name *
Grade *
Date of Absence *
MM
/
DD
/
YYYY
Please indicate yes or no for each symptom below for this student: *
Yes
No
Does anyone in your household have Covid-19?
Fever at or above 100.4
Cough
Chills or Muscle Aches
Chest Pain
Sore Throat
Nausea or Vomitting
Diarrhea
Headache
Smell and/or Taste Disorders
Abdominal Pain
Reason for Absence *
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of Oasis Academy. Report Abuse