*
Required
Attendance Information
Which of the following are you reporting?*
Absence
Tardy
Early Dismissal
Change in Dismissal
On what date?
*
required
(mm/dd/yyyy)
If this applies to a range of days, use this for the start date.
If applicable, what date is your child returning to school?
(mm/dd/yyyy)
Time of Early Dismissal
*
required
Please describe the change in dismissal.
*
required
Please note that we may need to follow up with you for further information, and that this form is not a substitute for a bus pass.
Name of person picking up student
*
required
Reason for Absence
*
required
If out for more than 3 days a professional’s note is required.
Reason for tardiness
*
required
If late due to a professional appointment a professional note must be provided.
Reason for early dismissal
*
required
Student Information
Student First Name
*
required
Student Last Name
*
required
Student's Grade Level
*
required
Please Select…
Pre-K AM
Pre-K PM
Kindergarten AM
Kindergarten PM
First Grade
Second Grade
Third Grade
Fourth Grade
Homeroom Teacher
*
required
Parent/Guardian Information
Adult First Name
*
required
Adult Last Name
*
required
Please send a confirmation email to the address below*: