Report an Absence

Please complete all the the information below. If we have any questions, a staff member will contact the student's parent/guardian for clarification. Thank you.

Student Name Student Name First Last
Student Number
Student's Grade

Student's Grade Pre-K K 1 2 3 4 5
Parent/Guardian Name Parent/Guardian Name First Last
Parent/Guardian Phone Number Parent/Guardian Phone Number - ### - ### ####
Parent/Guardian Email (If you would like a confirmation emailed to you)
Absent from Absent from / MM / DD YYYY
Return date Return date / MM / DD YYYY
I am reporting my student for being

I am reporting my student for being absent tardy
Does the student have new or worsening onset of any of the following symptoms?

Fever (greater than 100.4º), chills, sore throat, severe cold/cough that disrupts normal activities like sleep, repeated episodes of diarrhea or vomiting, and/or has distracting pain from earache, headache, or sore throat.

If yes, the student cannot remain at school or come on campus and is required to stay home for 24 hours AFTER the symptoms are gone without the use of over-the-counter medications to treat the symptoms.

Does the student have new or worsening onset of any of the following symptoms?

Fever (greater than 100.4º), chills, sore throat, severe cold/cough that disrupts normal activities like sleep, repeated episodes of diarrhea or vomiting, and/or has distracting pain from earache, headache, or sore throat.

If yes, the student cannot remain at school or come on campus and is required to stay home for 24 hours AFTER the symptoms are gone without the use of over-the-counter medications to treat the symptoms. Yes, my child has one or more of the symptoms. No, my child does not exhibit any symptoms listed above.
Reason for Absence(s) or Tardiness:

Reason for Absence(s) or Tardiness: Ilness of the student Major illness in the immediate family Death in the immediate family Religious holiday Religious instruction, conference, institutes, etc. Court order/subpoena Other (Please explain below) - may be excused pending administrative approval
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