Pre-Planned Absence Form printable pdf download

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