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.
Student Last Name
Student First Name
Teacher or Division Name
High School 9-12 Teachers
Intermediate 5-6 Teachers
Jr. High 7-8 Teachers
When did you first notice symptoms (If no symptoms put today's date)
Symptoms-Check all that apply
Shortness of breath
None of the above
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?
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?
Send me a copy of my responses.
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This form was created inside of New Covenant Academy.