Date: _______________________
My child ___________________________ was absent on ___________________ as a result of:
Please check the reason that applies to your child.
_____ | _____ | _____ | _____ | _____ | _____ | _____ | _____ | _____ | Parent/Guardian Signature: |
|---|---|---|---|---|---|---|---|---|---|
Illness (The school reserves the right to require medical confirmation of illness in the case of chronic or lengthy absences (beyond 5 days)). | Death in the Family. | Medical, Professional, or Legal Appointments (that cannot be scheduled after school hours). | Religious Observance (required by the tenets of the faith). | Family Emergency (explain) | Other Educational Experience (A detailed description of the learning experiences had by the student must be attached). | Hospitalization (explain) | Court Appearance. | Other: | ______________________________ |
Excused Absences include illness, death in the family, medical, professional or legal appointments, religious observance, family emergency, other educational experience, hospitalization and court appearance.
Unexcused Absences include any absence where written notificationof the reasons define under excused absences is not received within three days of the absence or absences due to reasons not listed under excused absences.
(For school office use only)
Date Received: _______________
Excused Absence | Unexcused Absence
