SRS Absence Reporting Form

Parents/guardians are asked to complete this form each day when reporting a student absent from school.  This information is kept confidential and policies regarding general illness and communicable diseases will be followed as stated.  The school nurse may follow up with the parent/guardian (when an absence relates to an illness or related to public health concerns) after the form is submitted.

THIS FORM IS TO BE USED FOR FULL DAY ABSENCES ONLY.  PLEASE CALL THE MAIN OFFICE - 985-1105- TO REPORT A STUDENT TARDY OR TO BE DISMISSED.  
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Email *
Student's Last Name *
Student's First Name *
Name of the parent/guardian filling out this form *
Parent/Guardian phone number where they can be reached today *
Date this absence is to be taken *
MM
/
DD
/
YYYY
The reason for this decision is *
Student's Grade Level *
Child's Teacher (Last Name)
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