Online Absence Report Form
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Online Absence Report Form
1.
Student's first and last name
*
2.
Date of Birth
*
Please list in mm/dd/yyyy format.
3.
Teacher's Name - Grade Level
*
Please select one
--Please Select--
Mr. Boden - Kindergarten
Mrs. Fountain - Kindergarten
Ms. Goshi - 1st Grade
Mrs. Harrison - 1st Grade
Mrs. Falls - 1st Grade
Mrs. Moreno - 2nd Grade
Ms. Stouffer - 2nd Grade
Mrs. Reger - 3rd Grade
Mrs. Wicker - 3rd Grade
Mrs. Zuber - 3rd Grade
Mrs. Campos - 4th Grade
Mrs. O'Neill - 4th Grade
Mrs. Shumaker - 5th Grade
Mrs. Hofmeyer - 5th Grade
Mrs. Fulkerson - 6th Grade
Ms. Myers - 6th Grade
Mrs. Zhao - Kindergarten
Mrs. Zhang - Kindergarten
4.
Date(s) of Absence
*
Please list in mm/dd/yyyy format.
5.
Reason for absence - Please click all symptoms that apply. Please use the Other line for symptoms not listed or write additional comments.
*
Sore Throat - Excused Absence
Stomach Ache - Excused Absence
Cold / Flu - Excused Absence
Fever - Excused Absence
Rash - Excused Absence
Chicken Pox - Excused Absence
Asthma / Allergy - Excused Absence
Earache - Excused Absence
Doctor / Dentist Appointment - Excused Absence
Vacation / Out of Town - UNEXCUSED Absence
Passport / Visa - Excused Absence
Other Illness - Excused Absence
Other, please specify
6.
Person Reporting Absence
*
(Only a parent / guardian may report an absence)
7.
Relationship to Student
*
8.
Today's Date
*
mm/dd/yyyy
9.
Phone Number
*
10.
Parent's / Guardian's Email Address
*
11.
Will you be requesting homework today?
*
PLEASE EMAIL YOUR CHILD'S TEACHER TO REQUEST HOMEWORK.
Will you be requesting homework today?
*
PLEASE EMAIL YOUR CHILD'S TEACHER TO REQUEST HOMEWORK.
Yes
No