*
Required
Date
*
required
(mm/dd/yyyy)
Student Full Name
*
required
Parent/Guardian Daytime Phone Number
*
required
Parent/Guardian Email Address
Absence Reason
*
required
Please Select…
Illness (10 absences or more medical note required)
Religious Holiday
Court Appearance (requires court documentation)
Funeral or Death in Family
Extraordinary Educational Opportunity (pre-approved)
Other (provide specific details)
If other, please explain reason:
Parent/Guardian Name
*
required
BY TYPING YOUR NAME BELOW AND SUBMITTING THIS FORM, YOU ARE CERTIFYING YOU ARE THE PARENT/GUARDIAN OF THE STUDENT NAMED ABOVE, AND UNDERSTAND THIS CONSTITUTES YOUR SIGNATURE. INTENTIONAL MISREPRESENTATION MAY HAVE LEGAL OR SCHOOL DISCIPLINE CONSEQUENCES.