Hawken School Absence Form

Hawken School Absence Form
Name of Student *

Student First Name Student Last Name
Division & Campus Location *

Lower School - Lyndhurst Middle School - Lyndhurst Middle School - University Circle Upper School - Gates Mills Upper School - University Circle Mastery School - University Circle
Grade *
Grade *
Grade *
Teacher/Advisor
Time of Absence *

Will be out one day Will be out more than one day Coming in late Leaving mid-day and returning Leaving early
Date of absence *

Month Day Year
Date
Dates of absence *
Date(s) and time(s) of absence *
Reason for absence *

Illness Appointment Travel Family Death/Funeral Observance of a Holiday College Visit Other

Reason for absence - additional information *
Symptoms *

Fever 100.0 or higher Headache Nausea/vomiting Body aches Extreme fatigue Chills New onset or worsening nasal congestion not associated with allergies Diarrhea Loss of smell or taste Sore throat New onset cough Chest pain or difficulty breathing Rash Eye drainage Tested positive for strep throat Tested positive for flu Tested positive for COVID-19 Other symptom or information, please explain
Explain additional symptoms or provide information
Is your child an in-season athlete?

Yes No N/A
What sports?
Contact name *

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