GCMS Student Required Absence Note
Name of Student *
Grade *
Date of Absence *
MM
/
DD
/
YYYY
Valid Excuse *
Parent/Guardian name *
Parent/Guardian phone number *
In the last 14 days, has your child experienced or currently experiencing any of the following symptoms? *
Required
Is your child experiencing any of the following symptoms that he/she does not normally experience? *
Required
Date that symptoms started
MM
/
DD
/
YYYY
Has your child had any known COVID contacts in the last 14 days?
Clear selection
Date of known exposure
MM
/
DD
/
YYYY
Has your child been tested for Covid since symptom onset?
Clear selection
Date of Covid test
MM
/
DD
/
YYYY
Covid test results
Clear selection
Has your child been seen by a doctor and given an alternative diagnosis?
Clear selection
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