Student Absence
To be filled out by the parent/guardian or school nurse. If your child/student is absent, please fill out the information below. This form only needs to be completed ONCE for each absence event (i.e. illness, travel, etc).
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Child's Name *
Child's School *
Child's Grade *
Please check all that apply *
Required
If you checked "Travel", where did child or family member travel to and for how long? Please provide any other important details
If your child is ill, check all that apply. If your child is not ill, select "None of the above" *
Required
Date of Absence/ Travel/ Onset of symptoms/ or Exposure *
MM
/
DD
/
YYYY
Is your child fully vaccinated? *
If "Yes" to fully vaccinated, which vaccine did your child receive: *
Other information you would like to provide
Person filling out this form *
Best Way to Contact You (Name and phone #) *
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