Please fill in the information requested below. An explanation from a student's parent/guardian for each absence/lateness/early release is required by Pennsylvania law. --Thank you
If you are reporting Vacation Time (5 days max/per school year), Do No Use This Form. Please contact your grade level principal: Upper School, Ms. Boyd or Lower School, Mrs. Herman.
Student's Last Name: First Name: Grade:
Attendance Event: AbsenceLatenessEarly Dismissal
Date of Event: (mm/dd/20xx)
Reason for Absence/Lateness/Early Release*:
Medical/Dental AppointmentIllness/InjuryBereavement/FuneralLegal/CourtFamily EmergencyVacationReligious Holiday/InstructionWeather
Time of Pick up:
Name of the person picking up student: Please be sure that person brings along his or her driver's license for identification.
Your First & Last Name: **
Your Phone Number:
Your Email Address:
**By submitting your name on this form, you are affirming that you are the parent/legal guardian of the listed student and that all information listed above is accurate and truthful.