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2026-2027 Disston Elementary School's Absence Form
Immediately following an absence, lateness or early dismissal please complete and submit this form. One form per child please.
* Indicates required question
Email
*
Your email
Email/correo electrónico
*
Your answer
Student Name/Nombre de estudiante
*
Your answer
Homeroom/Salon
*
Your answer
Date of Absence/ La fecha de ausencia
*
MM
/
DD
/
YYYY
How many days was your child absent?/Indica cuántos días falto:
*
Choose
1
2
3
4
5
6
7
8
9
10
Reason for Absence/ Razón de la ausencia
*
Your answer
Doctor's Note - Please upload/ Notas de doctor
Please note any absence of 3 days or longer should include a doctors note to be excused. Si la ausencia fue de 3 días o mas debes incluir una nota de medico.
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Parent's Name/Nombre de padre
*
Your answer
Parent's Contact# (needed to potentially discuss absence)/Número de teléfono
*
Your answer
A copy of your responses will be emailed to the address you provided.
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