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* Required
Student Last Name:
*
Your answer
Student First Name:
*
Your answer
Date of Absence
*
MM
/
DD
/
YYYY
Absence Type
*
Full Day
Part Day
Reason For Absence
*
Illness
My Student Tested Positive for COVID-19
Medical/Dental Appointment
Bereavement
Personal (Unexcused)
Other:
If your student tested positive for COVID-19, please enter the date they tested positive below so staff can determine their return to school date.
Your answer
Multiple Day Absence?
*
Yes
No
Multiple Day Absence Start Date
MM
/
DD
/
YYYY
Multiple Day Absence End Date
MM
/
DD
/
YYYY
My student attends Dry Creek's ELOP Afterschool Program.
*
Yes
No
Name of Person Reporting Absence
*
Your answer
Relationship to Student
*
Your answer
Email Address of Person Reporting Absence
*
Note: Email address subject to verification with student record.
Your answer
Contact Phone Number
*
Your answer
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.
Your answer
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