Online Form for Absence/Lateness/Early Release

Excuse for Absence/Lateness/Early Release

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Excuse For Absence, Lateness, or Early Dismissal

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

Do Not Use This Form if you are reporting Vacation Time (5 days max/per school year).  Please contact your grade level principal:  Upper School, Ms. Boyd or Lower School, Mrs. Herman.

Student's Last Name:   First Name:  Grade: 

Attendance Event:  

Absence=All Day, Lateness=Will not start the day, Early Dismissal=Start the day but will be out for all or part of the rest of the day (please estimate return time below in "early dismissal" section)

Date of Event:   (mm/dd/20xx)

Reason for Absence/Lateness/Early Release*:

*If Early Release:

  • Time Out:  
  • Time Back In (Estimated) (If your student will not be returning, use 3:30 pm)

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.

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