Please complete this form for each day your child will be absent.
Date of absence
Reason for Absence:
Out of Town
High school Visit
Other (please describe)
"Other" reason for absence
Is your child experiencing any of the following symptoms: (check all that apply)
New or worsening cough
Shortness of breath or difficulty breathing
New loss of taste or smell
Fever equal to or greater than 100.4°F OR feeling feverish (feels cold, staying under blankets, shivering, or hot to the touch).
Muscle aches or pains
Nasal congestion and/or runny nose
Nausea, vomiting, diarrhea, and/or abdominal pain
My child is NOT exhibiting any of these symptoms
Is anyone in your household exhibiting symptoms listed above?
Is anyone in your immediate household awaiting COVID-19 test results?
Has anyone in your household been exposed to a person testing positive for COVID-19?
Note for the nurse:
Please contact the school nurse for further instructions regarding when your student may return to school. firstname.lastname@example.org
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This form was created inside of Woodland Presbyterian School.