(様式１ 英語)
Reiwa

year

monthday

To Parents/ Guardian

Notice of suspension of attendance due to influenza
Isesaki City Municipal Toyouke elementary School
Principal Yumiko Tabei
Due to influenza your child will be suspended from attending school during the period when there is a risk ofinfecting other people according to the School Health and Safety Law.
The criteria for the suspension period for influenza are as follows.
＜The criteria for the suspension period for influenza.＞「Until 5 days have passed since the onset and 2days (3 days for infants) after the fever has
disappeared.」If you are diagnosed with influenza, please take sufficient medical treatment and recover before going to school.
When attending school, parents are requested to fill out the following “Medical Treatment Report for Influenza”,
and submit to the school.
(In addition if it is possible to go the school within 5 days due to a doctor’s diagnosis it is necessary to submit acertificate of a proof of recovery.)・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・
To the School Principal

Parents should fill out

Medical Treatment Report for Influenza
GradeSection Child・Student Name

１

Medical institution that undergone the medical examination：

２

Date of consultation：Reiwa

Pediatric Clinicyearmonthday（Type of diagnosis：A type

Date of re-attending the school：Reiwa

year

month

B typeunknown）※Please circle one of them.

３day(To resume school attendance both criteria 1 and 2 of the following suspension period must be met.)※Please write down the「date of the onset」and 「date of the fever get down」
Criteria for suspension period１

The day when symptoms such as fever appear (onset day) is set to 0 day, counting from thenext 5 days.⇒ Date of the onset：

２monthday

The day when the fever disappeared is 0 day and 2 days, (3 days the infants) have passed
since the next day. ⇒ Date of fever：Reiwayear

monthday

The matters mentioned above are true and correct.
Reiwa
Parent/ Guardian Nameyear

monthdaySeal (Hanko)

(英語 記入例)

SampleReiwa ２ year １２ month ７ day
To Parents/ Guardian

Notice of suspension of attendance due to influenza
Isesaki City MunicipalSchoolPrincipal
Due to influenza your child will be suspended from attending school during the period when there is a risk ofinfecting other people according to the School Health and Safety Law.
The criteria for the suspension period for influenza are as follows.
＜The criteria for the suspension period for influenza.＞「Until 5 days have passed since the onset and 2days (3 days for infants) after the fever hasdisappeared.」If you are diagnosed with influenza, please take sufficient medical treatment and recover before going to school.
When attending school, parents are requested to fill out the following “Medical Treatment Report for Influenza”,
and submit to the school.
(In addition if it is possible to go the school within 5 days due to a doctor’s diagnosis it is necessary to submit acertificate of a proof of recovery.)・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・
To the School Principal

Parents should fill out

Medical Treatment Report for Influenza
３ Grade１ Section Child・Student Name
〇 〇Isesaki Hanako

１

Medical institution that undergone the medical examination：

Pediatric Clinic

２Date of consultation：Reiwa ２year １２month ７day（Type of diagnosis：A type

B typeunknown）※Please circle one of them.

３

Date of re-attending the school：Reiwa ２ year １２

month １４ day(To resume school attendance both criteria 1 and 2 of the following suspension period must be met.)※Please write down the「date of the onset」and 「date of the fever get down」
Criteria for suspension period１

The day when symptoms such as fever appear (onset day) is set to 0 day, counting from thenext 5 days.⇒ Date of the onset： １２ month ７ day

２

The day when the fever disappeared is 0 day and 2 days, (3 days the infants) have passed
since the next day. ⇒ Date of fever：

１２ month ９ day

The matters mentioned above are true and correct.
Reiwa ２ year １２ month １４Parent/ Guardian Name

Isesaki Hanao

day

Seal (Hanko)