Escuela Student Absence Form

Non-Illness Related Absence *

Personal Day Appointment Vacation Religious Holiday Other (please specify)

Please select all symptoms your child has experienced over the last 24 hours. *

Cough Shortness of breath or difficulty breathing Fever or chills Fatigue Muscle or body aches Headache Sore throat Loss of taste or smell Diarrhea Congestion or abnormally runny nose Nausea or vomitting Other, please explain below

Have you tested your child for COVID-19?

What were the results?

Do Not Fill This Out

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