Student Absence Form 2022-2023
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1.
Child's Name
*
First and last name
2.
Child's Teacher
*
3.
Date of Absence
*
mm/dd/yyyy
4.
Reason for Absence
*
--Please Select--
Illness
Death in the Immediate Family
Medical or Dental Appointment
Court or Administrative Proceedings
Religious Observance
Other
5.
Comment about Absence
If you have selected "other" as a reason for absence you must add more information here.
6.
Grade
*
--Please Select--
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
7.
Parent's/Guardian's Name
*
8.
Phone Number
*
9.
Email Address
10.
Additional Comments