Student Absence
To be filled out by the parent/guardian or school nurse. If your child/student is absent, please fill out the information below.
Child's Name *
Child's School *
Child's Grade *
Today's Date *
MM
/
DD
/
YYYY
Please check all that apply *
Required
If you checked "Travel", where did child or family member travel to and for how long? Please provide any other important details
If your child is ill, check all that apply *
Required
Date of Onset of symptoms or Exposure
MM
/
DD
/
YYYY
Other information you would like to provide
Person filling out this form *
Best Way to Contact You (Name and phone #)
Submit
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