CTSD STUDENT ABSENCE REQUEST FORM
PLEASE COMPLETE THIS FORM TO REPORT EACH DAY YOUR CHILD IS ABSENT. PLEASE NOTE THE REASON FOR ABSENCE FOR SUBMISSION TO OUR SCHOOL NURSE.
Email address *
NAME OF PERSON COMPLETING THE FORM *
Your answer
RELATIONSHIP TO STUDENT *
Your answer
STUDENT FIRST NAME *
Your answer
STUDENT LAST NAME *
Your answer
SCHOOL ATTENDING *
DATE OF ABSENCE *
MM
/
DD
/
YYYY
REASON FOR ABSENCE *
PLEASE LIST SYMPTOMS, EXAMPLE: HIGHEST FEVER, VOMITING, DIARRHEA, COUGH
Your answer
SEEN A DOCTOR *
A copy of your responses will be emailed to the address you provided.
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