Student Daily Absence

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Please complete the form to clear your child's absence for the day.

Student First Name *

Student Last Name *

Teacher Name *

Person Completing the Form *

Date/Dates of Absences

YYYY

Reason for Absence - Illness

Fever (Must be fever free for 24 hours)

Vomiting (Must be vomit free for 24 hours)

Diarrhea (Must be diarrhea free for 24 hours)

Dr. Appt

Dentist Appt

Eye Dr. Appt

Cough (if allergies you can come to school)

Runny Nose (if allergies you can come to school)

Sore Throat (if allergies you can come to school)

Earache

Stomach Ache

Other:

Reason for Absence

Out of Town

Reason for Absence

Death in the family

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This form was created inside of Acton-Agua Dulce Unified School District.

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