Mesa: Absence/Tardy Report Form

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Please provide documentation for any appointments to be marked as 'Excused' (doctor, dental, etc.)
Appointment slips may be emailed to jallen@ffc8.org or faxed to 719-382-8520

Email *

ATTENDANCE POLICY

FIRST DATE of the Absence/Tardy

STUDENTS MUST STAY HOME until the following symptoms are resolved without medication for 24 hours:

Fever (fever is considered 100.4 or greater)

Vomiting

Diarrhea

YYYY

LAST DATE of the Absence/Tardy

STUDENTS MUST STAY HOME until the following symptoms are resolved without medication for 24 hours:

Fever (fever is considered 100.4 or greater)

Vomiting

Diarrhea

YYYY

Student's Teacher *

Student's First & Last Name *

Adult's Relationship *

Mother/Stepmother

Father/Stepfather

Guardian/Foster Parent

Grandparent

Other:

Reason for Absence/Tardy (if sick, please list symptoms) *

Would you like the nurse to call you? *

Yes

If you would like a call from the nurse, please provide your phone number

Send me a copy of my responses.

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