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Student's Name*
COVID-19 Reporting
Student Absence
Covid Reporting AND Absence
Travel Requiring COVID 19 Quarantine:
If the student or anyone in the student's household has traveled to any state that is currently on the list of states that NJ has quarantining requirements for, please report in the BOX ABOVE: 1. WHO in the household, 2. STATE, 3. DATE of travel and Length of time spent there, and 4. PRECAUTIONS taken in the household to quarantine. The Nurse will contact you for further info. and with next steps.
Possible COVID-19 Exposure/Positive Testing:
If you believe the student or anyone in your household has possibly been exposed to COVID-19, or if they have tested positive, reporting this is required here. Please report in the BOX ABOVE: 1. WHO in the household was possibly exposed or tested positive, 2. DATE of possible exposure or positive test, and 3. HOW possibly exposed. The Nurse will contact you for further info. and with next steps.
STUDENT ABSENCE REPORTING:
Date(s) of Absence
Today's Date* January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2023 2022 2021 2020 2019 2018
Name of Parent/Guardian reporting absence or COVID data (if not parent/guardian, please explain below)*
Pre-K (3 & 4 year olds)
Kindergarten
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
24 mo. - 3 yr old Program
Tested Positive for Covid-19
Illness, all other illnesses
Medical Appt
Christian Youth Retreat
Missions Trip
Death in Immediate Family
Vacation/Other Type of Personal Day
Other (explain below)
Yes
No
Explanation of Absence (required)