Parent/Guardian Absence Note for Student

Today’s Date: 	

First and Last Name of Student: 	

Please Excuse:	Absence	/	Late Arrival (Partial-Day)	/	Early Dismissal (Partial-Day) (Circle which applies)

Reason for time missed (check which applies):
Student illness
	Doctor/Dentist appointment
	
Death in the family
	Board approved enrichment activity
	
Illness in the student’s family
	Quarantined for a contagious disease
	
Religious holiday/reason
	Mandated court appearance
	
Immigration circumstances
	Foster care placement
	
Other: 	

Date(s) of Absence: 	

Parent/Guardian Name: 	
(Please Print)

Parent/Guardian Signature: 	

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

Parent/Guardian Absence Note for Student

Today’s Date: 	

First and Last Name of Student: 	

Please Excuse:	Absence	/	Late Arrival (Partial-Day)	/	Early Dismissal (Partial-Day) (Circle which applies)

Reason for time missed (check which applies):
Student illness
	Doctor/Dentist appointment
	
Death in the family
	Board approved enrichment activity
	
Illness in the student’s family
	Quarantined for a contagious disease
	
Religious holiday/reason
	Mandated court appearance
	
Immigration circumstances
	Foster care placement
	
Other: 	

Date(s) of Absence: 	

Parent/Guardian Name: 	
(Please Print)

Parent/Guardian Signature: 	

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