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Parent/Guardian Last Name
Parent/Guardian First Name
Contact Number (###) ###-####
Phone number where we can reach you:
It is important that you report your child’s absence/tardy/early dismissal and click any symptoms that they are experiencing.
Student Last Name
Student First Name
New Providence High School
New Providence Middle School
Allen W. Roberts Elementary School
Salt Brook Elementary School
Date of Absence/Tardy/Early Dismissal
If this applies to a range of days, use this for the start date.
If, applicable, on what date will the absence end?
My child will be:
Absent from school.
Tardy to school.
Leaving school early.
Reason for Absence/Tardy/Early Dismissal:
Please be specific with description or diagnosis and select any symptom that your child is experiencing (this information will remain confidential). In the case of Tardy/Early Dismissal, please be specific with the times. ***In the event you were notified that your child should remain home due to a COVID related matter, but will complete their school work and engage in teacher support hours, please specify that below. Your child will be marked as QUR (Quarantining for the day), and their attendance will not be penalized.***
Fever (measure or subjective)
Myalgia (muscle aches)
Nausea or vomiting
Congestion or runny nose
Shortness of breath
New loss of smell
New loss of taste
My child is not experiencing any of these symptoms
Symptom Start Date
If, applicable, on what date did these symptoms begin?
If absent due to travel, are you travelling OUTSIDE of the contiguous United States?
YES, this absence is due to traveling OUTSIDE of the US
No, we are traveling within the US
A copy of your responses will be emailed to the address you provided.
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This form was created inside of New Providence School District.