Online Absence Report Form
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Online Absence Report Form
1.
Student's Name - Date of Birth
*
Please list in mm/dd/yyyy format.
2.
Teacher's Name - Grade Level
For example: Mrs. Smith - Grade 4
3.
Date(s) of Absence
*
Please list in mm/dd/yyyy format.
4.
Reason for absence
*
Reason for absence
*
Sore Throat - Excused Absence
Stomach Ache - Excused Absence
Cold / Flu - Excused Absence
Fever - Excused Absence
Rash - Excused Absence
Chicken Pox - Excused Absence
Asthma / Allergy - Excused Absence
Earache - Excused Absence
Doctor / Dentist Appointment - Excused Absence
Vacation / Out of Town - UNEXCUSED Absence
Passport / Visa - Excused Absence
Other Illness - Excused Absence
Other, please specify
5.
Person Reporting Absence
*
(Only a parent / guardian may report an absence)
6.
Relationship to Student
*
7.
Today's Date
*
mm/dd/yyyy
8.
Phone Number
*
9.
Parent's / Guardian's Email Address
*
10.
Will you be requesting student homework today?
*
If so, homework can be picked up in the office between 3:00 p.m. and 4:30 p.m.
Will you be requesting student homework today?
*
If so, homework can be picked up in the office between 3:00 p.m. and 4:30 p.m.
Yes
No
