Student's Name:
Date of Absence (first day of absence):
Additional Date(s) of Absence (an electronic absence form will NOT BE ACCEPTED for any student accumulating ten or more total absences or more than three consecutive days. A physican's note MUST be submitted to the school for these absences.):
mm/dd/yyyy
Reason for the Absence:
Please describe reason for the absence.
Parent/Guardian email address - Please provide a valid email address in order to use this electronic form. 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: