Randolph Attendance Form
Please Note: All fields marked with a red Asterisk are required fields.
To be completed by parent/legal guardian only.
Student First Name
Student Last Name
Teacher Last Name
In this box, please type your first and last name.
Please check yes below to acknowledge the following statement: "By checking the signature box, I certify that I am the legal guardian of this child and all of the information provided to Livonia Pubic Schools School District is accurate"
Reason for Absence
Please select the reason for your child's absence from the list below.
Is the reason for absence due to a communicable disease?
If not, select "No." Otherwise, please select the disease your child has been diagnosed with. This question is required to comply with county standards.
Conjunctivitis (Pink Eye)
Pertussis (Whooping Cough)
Date of Absence
If absence is multiple dates, please select the first absence date.
Multiple Day Absence Ends
If absence is multiple dates, please select the last absence date.
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