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ECDC Program - Report an Absence
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* Indicates required question
Email
*
Your email
Student Name:
*
Your answer
Parent Name:
*
Your answer
Phone Number:
*
Your answer
Date(s) of Absence
*
MM
/
DD
/
YYYY
Reason for absence:
*
Illness (If you check this box, please see question below)
Other: (If Other is selected, please add the reason in the text field below.)
Required
Other Reason:
Your answer
Please check any symptoms that your child is exhibiting:
*
Fever over 100
Cough
Shortness of breath
Runny nose/congestion
Nausea, vomiting, or diarrhea
Fatigue
New loss of taste/smell
Headache
Muscle or body aches
Poor appetite
Other, please describe reason below
Required
Other Reason:
Your answer
A copy of your responses will be emailed to the address you provided.
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