Family Leave Request Form - Bridgeway Christian Academy

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Family Leave
Request Form
Family Last Name:
_____________________________________________________
Student(s): __________________
Teacher(s): ____________________
____________________
____________________
____________________
____________________
Family Leave Date(s) Requested:
From:
/_ _/
To:
_/
/____
Reason for Request: ______________________________________________________
Parent Signature: ___________________________________ Today’s Date: ___ / ___ /___
The following guidelines must be followed by students on family leave:
 See teacher(s) in advance of departure concerning homework and class work.
 Homework, class work, and tests must be completed and/or turned in the day
your student returns to school.
 Approved family leave days are considered excused absences, but are counted in
the absence policy.
Approval – Bridgeway Personnel
Approved by:
_______
_
_____
(Please print name here.)
Signature: ____________________________________
Date:
/
/____
4755 Kimball Bridge Rd., Alpharetta, GA 30005 | phone: 770.751.1972 | fax: 678.942.1159
bridgewayca.org
Family Leave
Request Form
Family Last Name:
_____________________________________________________
Student(s): __________________
Teacher(s): ____________________
____________________
____________________
____________________
____________________
Family Leave Date(s) Requested:
From:
/_ _/
To:
_/
/____
Reason for Request: ______________________________________________________
Parent Signature: ___________________________________ Today’s Date: ___ / ___ /___
The following guidelines must be followed by students on family leave:
 See teacher(s) in advance of departure concerning homework and class work.
 Homework, class work, and tests must be completed and/or turned in the day
your student returns to school.
 Approved family leave days are considered excused absences, but are counted in
the absence policy.
Approval – Bridgeway Personnel
Approved by:
_______
_
_____
(Please print name here.)
Signature: ____________________________________
Date:
/
/____
4755 Kimball Bridge Rd., Alpharetta, GA 30005 | phone: 770.751.1972 | fax: 678.942.1159
bridgewayca.org

Download Family Leave Request Form - Bridgeway Christian Academy

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