Please type in the child's name: First Name: Last Name:
My name is:
My phone number is:
I am the legal guardian of this child: yes no
My child will not attend school today (please check):
My child has: (use ctrl to select multiple options) Fever Sore throat Confirmed Strep Cold Stomach flu Head lice Other
Estimated length of absence (please choose one): Only today Less than 3 days More than three days Don't know
His/her classroom teacher is: unselected K Straight K Malengo 1 DuMars 1 McCanna 2 O'Neill 2 Stoner 3 Dickey 3 Hedges 3 Smoral 4 Freely 4 Ross 5 McCarty 5 Miller
Additional information: