Daily Student Absence Form For Illness
Parents please complete DAILY all questions on the form and complete the form individually for each student being reported absent, arriving late, or leaving early for appointments. Thank you.
Student Last Name *
Student First Name *
Student's Grade *
Elementary Student's Homeroom Teacher
Is your student arriving late or leaving early today? Please specify times and reason.
Is your student at home due to close contact with an individual testing positive for COVID-19 in the last 10 days? (quarantine)
Clear selection
Has your student been diagnosed with COVID-19 by a health care provider in the last 10 days? (isolation)
Clear selection
Is your child at home waiting for COVID-19 test results?
Clear selection
Please check all the symptoms that your student has experienced in the last 24 hours:
Has your child been vaccinated against COVID19?
Clear selection
Does your child participate in before/after/wrap around care?
Clear selection
Does your student ride the bus?
Clear selection
Guardian Last Name, First Name *
Guardian Cell Phone Number *
Is there anything else you would like to share with us?
Never submit passwords through Google Forms.
This form was created inside of hartlake.org. Report Abuse