Child's Name *

First Name

Last Name

Name of Parent Making Report

First Name

Last Name

Phone Number of Parent Making Report

(###)

###

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Report *

Please mark what kind of report you are making.

Absent | Due to Illness

Absent | NOT Due to Illness (i.e. planned vacation)

Absent | My child must quarantine or isolate

Absent | Other

Travel Alert | For Child and Family

Travel Alert | For a Family Member or Close Contact