Absence Reporting Form

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Parent Full Name *

Contact Number *

Child's Full Name *

Child's Class / Year group *

Does your child have a high temperature? *

Yes

If yes, how high is their temperature? (degrees)

Does your child have a new continuous cough? (coughing a lot for more than an hour, or three or more coughing episodes in 24 hours) *

Yes

Does your child have a loss of, or change in sense of smell or taste? *

Yes

If you have answered 'yes' to one or more of the above, please leave a day time contact number (if different from above)

If your child has any other symptoms please state what they are below:

Vomiting

Diarrhoea

Headache

Sore throat

Runny/blocked nose

Upset stomach

Other:

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If your child's absence is not due to sickness please let us know the reason

Please note – your child does not need a test if they have a runny nose, are sneezing or feeling unwell but do not have a temperature, cough or loss of, or change in, sense of smell or taste because these are not normally symptoms of coronavirus. *

Please tick to acknowledge you have read and understood the above

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