Attendance Form

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Attendance Form

If your student is going to be absent or late, please fill out this form. This form is in place of the attendance line.

Student Last Name *

Student First Name *

Absence date *

YYYY

Reason for absence or tardy *select all that apply* *

Influenza *Confirmed diagnosis*

Covid-19 *Confirmed diagnosis*

Strep Throat *Confirmed diagnosis*

Pneumonia *Confirmed diagnosis*

Pertussis / Whooping Cough *Confirmed diagnosis*

Fever

Respiratory Illness

Gastrointestinal illness (stomach)

Sore Throat

Pink Eye

Ear Infection

Medical Appointment

Other Appointment

Mental Heath

Family Vacation **STOP** (please complete the trip form located on the school website)

Required

If your student has a confirmed diagnosis, (covid, flu, strep, pertussis, pneumonia) please provide date of diagnosis. *

Other - if reason not listed above please provide reason.

Grade Level *

Preschool

Kindergarten

First

Second

Third

Fourth

Fifth

Sixth

Seventh

Eighth

Homeroom Teacher Name (if known) *

My student will be late *

Yes

Name of Person Completing Form *

Phone number *

Submit

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