Student Name:
Gender: Male Female
Grade Level: 6th Grade 7th Grade 8th Grade
Date of Absence:
Parent Full Name:
Parent's Email: (a summary of this submission will be sent)
Phone Number: Home Cell Work
Absence Reason: Sickness Doctor's Appointment Dental Appointment Family Issue Other
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.
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