Absent Student Questionnaire
Good morning!
We understand that your student will not be attending school today. Please fill out this health questionnaire to help us better understand your student's absence.

Please include how long you anticipate he/she will be out and their specific symptoms. This is important information for us, particularly due to the heightened awareness of COVID-19 at this time.

This information can help with assessing your student's symptoms and how long they need to be out. This questionnaire will also help us in arranging for your student to participate in our Temporary Home Education Option (THEO), as needed.

If more than one of your children are absent, please note each child's name and grade below.

If you have any concerns or questions regarding your child's health, please email our school nurse Debbie Smith at dsmith@ckcs.net. She will also follow up, when needed, via email due to your response in this questionnaire.

Please complete the form each day your child is absent from school.

Thank you!

Email address *
Student Name(s) *
Home Room Teacher(s)/Grade: *
Please clarify the reasons for your student's absence: *
To help better understand your student's illness, please check all of the following symptoms that apply: *
What date did your student's symptoms start? (if illness does not apply to you, please answer n/a) *
Please note any additional information you would like to share in regards to your student's absence: *
I understand that if my student is showing any symptoms of illness, they will automatically need to stay home a minimum of 48 hours from symptom onset.
If your student(s) will be absent for 3 days or more, will your student require materials from their class in order to participate in PCK's Temporary Home Education Option (THEO)? *
I understand that if my student is absent 3 days or more because they are ill or in quarantine, Mrs. Myers, THEO Coordinator, will be in contact with me regarding pick-up of materials, coordination with their Home Room teacher, other needed accommodations, and getting my student started in the THEO program. *
I understand that if my student is ill for more than 3 days, he/she must remain home for a 10 day isolation. If I wish my student to return prior to the full 10 days, I must present a negative PCR COVID test. *
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