Pre-planned Absence Form

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PRE-PLANNED ABSENCE FORM
Parental Request To Have Student Released From Classes
Date: ________________________ Grade: ____________ Student I.D.# _________________
I, ____________________________(mother/father/guardian) of _________________________
request the release of my (son/daughter) from classes for _________ school days during the
period beginning ___________________________ and ending _________________________.
The reason I am making this request is:_____________________________________________
_____________________________________________________________________________
____________________________________________________________________________.
I understand that my (son/daughter) assumes primary responsibility for keeping up with school
work during this period of voluntary absence and that (he/she) will notify teaches in advance so
that assignments can be completed PRIOR to the absence. Have the teachers sing the bottom
indicating they know the student will be missing from the class, and that they have discussed
the work that will be due during the time of the absence. I further understand that certain
classroom activities such as films, speakers, labs and class discussions cannot be duplicated and
may result in a lower achievement grade.
FINALLY, I AM AWARE THAT STAPLES HAS AN ATTENDANCE POLICY WHICH
LIMITS TOTAL ABSENCES (EXCUSED OR UNEXCUSED) IN ANY GIVEN COURSE.
AT 10 ABSENCES IN ONE SEMESTER, A STUDENT’S CONTINUATION IN THE
COURSE WILL BE EVALUATED.
Forms submitted after the absence will NOT be accepted.
_______________________________________________
SIGNATURE OF PARENT OR GUARDIAN
***I would be available to meet with you to review assignments during this absence. Thank
You.
TEACHERS’ SIGNATURES
(Teachers’ signatures indicate ONLY that the student has informed you of an upcoming
absence. It does NOT signify approval.)
1. ____________________________________ 5. ___________________________________
2. ____________________________________ 6. ___________________________________
3. ____________________________________ 7. ___________________________________
4. ____________________________________ 8. ___________________________________
THIS FORM MUST BE COMPLETED AND RETURNED BEFORE
THIS ABSENCE.
PRE-PLANNED ABSENCE FORM
Parental Request To Have Student Released From Classes
Date: ________________________ Grade: ____________ Student I.D.# _________________
I, ____________________________(mother/father/guardian) of _________________________
request the release of my (son/daughter) from classes for _________ school days during the
period beginning ___________________________ and ending _________________________.
The reason I am making this request is:_____________________________________________
_____________________________________________________________________________
____________________________________________________________________________.
I understand that my (son/daughter) assumes primary responsibility for keeping up with school
work during this period of voluntary absence and that (he/she) will notify teaches in advance so
that assignments can be completed PRIOR to the absence. Have the teachers sing the bottom
indicating they know the student will be missing from the class, and that they have discussed
the work that will be due during the time of the absence. I further understand that certain
classroom activities such as films, speakers, labs and class discussions cannot be duplicated and
may result in a lower achievement grade.
FINALLY, I AM AWARE THAT STAPLES HAS AN ATTENDANCE POLICY WHICH
LIMITS TOTAL ABSENCES (EXCUSED OR UNEXCUSED) IN ANY GIVEN COURSE.
AT 10 ABSENCES IN ONE SEMESTER, A STUDENT’S CONTINUATION IN THE
COURSE WILL BE EVALUATED.
Forms submitted after the absence will NOT be accepted.
_______________________________________________
SIGNATURE OF PARENT OR GUARDIAN
***I would be available to meet with you to review assignments during this absence. Thank
You.
TEACHERS’ SIGNATURES
(Teachers’ signatures indicate ONLY that the student has informed you of an upcoming
absence. It does NOT signify approval.)
1. ____________________________________ 5. ___________________________________
2. ____________________________________ 6. ___________________________________
3. ____________________________________ 7. ___________________________________
4. ____________________________________ 8. ___________________________________
THIS FORM MUST BE COMPLETED AND RETURNED BEFORE
THIS ABSENCE.

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