Student Name and Advisory
Date of Absence
Full Day or Partial Day?
If partial day, specify times below:
If you are reporting that your child normally attends school in the building but will be working from home today, please note that here:
Reason for Absence:
Personal Family Reason
Dentist or Doctor Appointment
Illness (please select symptoms and provide details below)
SYMPTOMS of ILLNESS (please select all that apply)
Fever (please also include temperature below)
New and/or Worsening Cough
Shortness of Breath or Difficulty Breathing
New loss of taste or smell
Fever - please fill in temperature below:
Other Illness Details:
Has your child or anyone in your home been tested for COVID and waiting for results?
If you would like to speak to our school nurse, Sharon Miller, she can be reached at
Send me a copy of my responses.
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This form was created inside of Northfield School of Arts and Technology.