Student Name:
Gender: Male Female
Student's 6th Grade 7th Grade 8th Grade
Homeroom Teacher:
Date of Absence:
Parent's Full: Name
Parent's Email: Address
Phone Number:
Phone Number: Home Cell Work Type
Reason for Absence: Student Illness Medical or Dental Appointment Death in student's family Observance of a religous holiday
Family Emergency Unsafe Weather Conditions Other *fill in reason below
Define "Other":
Additional Comments:
*By checking the box below, you are certifying that you are in fact the parent of the child in question, have the legal authority to make such decisions, and do provide the reasons for the absence in question.
Signature * Certification
By submitting this form, you do NOT need to call the office to report the absence NOR do you need to write out a physical note. This report will act as your note to the office.