Hawken School Absence Form

Hawken School Absence Form
Name of Student*

Student First NameStudent Last Name
Division & Campus Location*

Early Childhood - LyndhurstLower School - LyndhurstMiddle School - LyndhurstUpper School - Gates MillsMastery School - University Circle
Grade
Grade*
Grade*
Grade*
Teacher/Advisor
Time of Absence*

Will be out one dayWill be out more than one dayComing in lateLeaving mid-day and returningLeaving early
Date of absence*

MonthDayYear
Date
Dates of absence*
Date(s) and time(s) of absence*
Reason for absence*

IllnessAppointmentTravelFamily Death/FuneralObservance of a HolidayCollege VisitOther

Reason for absence - additional information*
Symptoms*

Fever 100.0 or higherHeadacheNausea/vomitingBody achesExtreme fatigueChillsNew onset or worsening nasal congestion not associated with allergiesDiarrheaLoss of smell or tasteSore throatNew onset coughChest pain or difficulty breathingRashEye drainageTested positive for strep throatTested positive for fluTested positive for COVID-19Other symptom or information, please explain
Explain additional symptoms or provide information
Is your child an in-season athlete?

YesNoN/A
What sports?
Contact name*

Parent/Guardian First NameParent/Guardian Last Name
Contact email*
example@example.com
Contact phone number*
If the reason for absence is illness, we will contact you.
Please verify that you are human*
Should be Empty: