Yerba Buena Elementary School Absence Reporting

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

If student will be absent for multiple days please call the office, at 818-889-0040

* Indicates required question

Student's First Name *

Your answer

Student's Last Name *

Your answer

Date of absence *

MM

/

DD

/

YYYY

Teacher's Name *

Your answer

Reason for absence *

Illness

Out of town

Religious holiday

Death in family

Medical/Dental Appointment

Other:

Your name *

Your answer

Your relationship to student *

Parent

Grandparent

Legal Guardian

Other:

Phone number where you can be reached *

Your answer

Comments

Your answer

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Las Virgenes Unified School District.

Help and feedback