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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