COVID-19 Information
When to Quarantine & Isolate as Defined by Public Health
Student Last Name: *
Student First Name: *
Date of Absence *
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Absence Type *
Reason For Absence *
Symptoms: please check all that apply. This will help staff determine if a student may need to quarantine or isolate (please see above graphic for descriptions) *
Required
Additional Comments (Optional):
Multiple Day Absence? *
Multiple Day Absence Start Date
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Multiple Day Absence End Date
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Name of Person Reporting Absence *
Relationship to Student *
Email Address of Person Reporting Absence *
Note: Email address subject to verification with student record.
Contact Phone Number *
Electronic Signature and Acknowledgement *
By entering my name below, I attest that I am the parent/guardian of the above-named student and all the information provided is accurate.
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