Attendance Form

Date of Absence

Consecutive Day Absences

Check this box if you wish to report consecutive day absences.

Specific Consecutive Dates

Please list the specific consecutive dates of the absence.

Student's First Name

Student's Last Name

Grade

Teacher

Reason or if ill, be specific about symptoms or diagnosis, such as: fever, cough, sore throat, vomiting or diarrhea.

Parent/Guardian Contact Information

Parent/Guardian First Name

Parent/Guardian Last Name

Phone Number

Alternative Phone Number

Parent/Guardian Email Address