Boger Absence Excuse Form

1.	Child's Name* First and last name

2.	Homeroom Teacher*

3.	Date of Absence*
	mm/dd/yyyy

4.	Reason for Absence*
	--Please Select--IllnessDeath in the Immediate FamilyMedical or Dental AppointmentCourt or Administrative ProceedingsReligious ObservanceOther

5.	Grade*
	--Please Select--Kindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade

6.	Parent's/Guardian's Name*

7.	Email Address

8.	Phone Number*

9.	Additional Comments