Student's Name:
Student's Grade:
Date of Absence (first day of absence):
Additional Date(s) of Absence:
Please note that an electronic absence form will not be accepted for any student accumulating 10 or more total absences or more than three consecutive days. A physician's note must be submitted to the school for these absences.
mm/dd/yyyy
Reason for the Absence:
Please describe the reason for the absence.
Parent/Guardian Email Address:
Please provide a valid email address. Excuse form submissions will not be accepted from a student email account.
Parent/Guardian Signature:
By entering my name in the box below, I attest that I am the parent/guardian of the above-named student.
Electronic Signature: Date: