Request For Time-Off
First and last name
Start date and time- (Ex: 7/18/19, starting at 8am; 7/20/19, all day or 10/9/19, starting at 6pm)
End date and time (Ex: 7/18/19, ending at 10pm; 7/20/19, all day or 10/10/19 ending at 6pm)
Type of leave
Sick leave (Illness or Injury)
Bereavement leave (Immediate Family)
Bereavement leave (Other)
Jury duty or legal leave
Reason for leave (if cancelling a session with less than 24 hours notice, please email Doctors Note, picture of car accident/car in shop if applicable)
Do you have any scheduled sessions that you will need a backup for? If so, refer to "ClearCare Future Sessions". You will find this link in our website.
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This form was created inside of Autism, Respite, Camp, & Childcare Center, LLC.