Absence Report Due to Illness or COVID related issue (ie; close contact positive, waiting on a test, etc.)
This form will be used to report a student's absence from school to the health office at New Covenant Academy. (One form per student must be completed). Depending on how you answer these questions, you may receive a follow-up call from one of NCA's nurses.
Email address *
Today's Date *
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Student Last Name *
Student First Name *
Grade *
Teacher or Division Name *
When did you first notice symptoms (If no symptoms put today's date) *
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Symptoms-Check all that apply *
Required
Provide any additional symptoms not noted above
Optional: You may use this space to explain to NCA's health office what is going on with your child.
Have you consulted a doctor about this illness? *
If you answered "No" to the above question, do you plan on consulting a doctor for this illness?
Clear selection
Full Name of the individual completing this form *
What is your relationship with the student? *
What is the best phone number that our Health Office personnel can reach you at, should they need to follow-up with you? *
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