*
Required
Student First and Last Name
*
required
Your Name
*
required
Your Email
*
required
Your Phone Number
*
required
Relationship to Student
*
required
Select Student Grade Level
*
required
Please Select…
Pre-K
Kindergarten
1
2
3
4
5
6
7
8
Select Absence Reason*
To understand how air quality may be affecting student health, BVSD is collecting health-related student attendance data. This information will be used to understand current air quality conditions and identify ways to improve air quality. For more information, go to bvsd.org/airquality.
Non-health (Indicate reason below as Additional Information.)
Asthma
Not asthma, but is respiratory related (such as, runny nose, sore throat, congestion or cough)
Gastrointestinal (such as stomach ache, nausea, vomiting or diarrhea)
Other health
Date of Absence
*
required
(mm/dd/yyyy)
Last Day of Absence
(mm/dd/yyyy)
Time of early pickup or late dropoff, if applicable
Additional Information