Pre-Authorized Planned Absence Form

Date: __________________	1st trip/vacation	2nd trip/vacation

Student Name: ____________________________________Grade/ Teacher: __________________________

Reason for Absence: _______________________________________________________________________

________________________________________________________________________________________

Last day of attendance: _____________________________________________________________________

Expected return date: _______________________________________________________________________

Please read before signing at bottom:
•	I understand that this form MUST be turned in PRIOR to the trip/vacation.

•	 I understand that my child is allowed ONE planned trip/vacation of up to 30 consecutive hours (5 days) absent from school each year.

•	 I understand that this document is to notify the school of my child’s non-emergency trip/ vacation. The time missed will be documented as excused absences when this form is received.

•	 I understand that my student is allowed a 2nd trip/vacation of up to an additional 30 consecutive hours (5 days) if requested through this document.

•	 If NOT approved for additional hours (2nd trip/vacation), these additional hours will be marked UNEXCUSED and count toward truancy.

•	 I agree that my child will complete and turn in all assigned schoolwork and tests to his/her teacher within the equivalent / same amount of days my child missed (3 days absent = 3 days to turn in make-up work, test, etc.).

•	 I understand that my child’s grades will be calculated through the completion of assigned work and tests.

•	 I understand the Reynoldsburg City Schools Board Policy regarding school absences as printed in the Student Handbook.

Parent/Guardian Name: ________________________________ Phone Number:_____________________

Parent/Guardian Signature: _________________________________________

____________________________________ Superintendent/Designee Signature

____________ Date

Approved for Excused Absence

**Please return completed form to the student’s teacher.

www.reyn.org                    7244 E. Main Street, Reynoldsburg, Ohio 43068	(614) 501-1020

4/11/19