Elementary School Excuse Note

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ELEMENTARY SCHOOL EXCUSE NOTE

Please fill out and submit this form when your child is absent.

Please explain why your child was absent. Documentation must be received within 2 days of
your child returning to school. If your child is out 5 or more consecutive days, a note from
his/her doctor must be brought in. After 3 days with no note your child’s absence will be marked
as unexcused.

My child,__________________________________________, was absent from school on:

List specific dates_______________________________________________________________

Specific reason for absence________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Parent’s signature _______________________________________________Date____________

Homeroom Teacher _____________________________________________Date____________

Principal’s signature _____________________________________________Date____________

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
FOR OFFICE USE ONLY

Date received _____________

Was excuse note received within 2 days of absence? Yes No

Was note from doctor received for 5 consecutive absences? Yes No

Attendance Secretary entered in Power School: Excused Unexcused (initials) ____________

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