Roxbury Central School Absence Reporting Form
DescriptionThis form may be used to report all excuses for tardiness, absences, or early dismissals. A phone call to
ext. 20, a written excuse, Dr’s. note or this form must be used for an excused absence. Parents are
requested to return this form filled out and signed as soon as their student returns to school. All reported absences must be documented within 48 hours after returning to school to be considered an excused absence
* Required
Student's Name
*
Your answer
Grade
*
Your answer
Reporting for the following date/s
*
Your answer
Reason for report
Was absent
Was late
Is to be dismissed at:
Your answer
Legal Absence
*
Dr. Appt.
Dentist Appt.
Illness
Eye Appt.
Death in Family
Court
Military
College Visit
Family Emergency
Other:
Required
If "other" is selected please describe below. Any other absence must be cleared through administration to be considered excused
Your answer
Name and contact information for person completing form
*
Your answer
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