Student Absence Form
Parent's Name
*
First
Last
Parent Primary Phone
*
Parent Email
*
Child''s Name
*
First
Last
Grade Level
*
Select one
Preschool
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
Homeroom Teacher
*
Enter Additional Siblings Absent Below If Necessary
Dates of Absence
Date Absent From:
MM slash DD slash YYYY
Date Absent To:
MM slash DD slash YYYY
Is this a partial day absence?
*
Yes
No
If partial day, what hours will be missed?
Reason for Absence
*
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