Excuse Form (Sample)
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1EXCUSE FORM
EXCUSE FORM
BEDFORD AREA SCHOOL DISTRICT
BEDFORD AREA SCHOOL DISTRICT
BEDFORD ELEMENTARY
BEDFORD ELEMENTARY
TO: Elementary Attendance Office
TO: Elementary Attendance Office
Name of Student:
Name of Student:
Grade: _____________ Teacher
Grade: _____________ Teacher
Today’s Date:
Today’s Date:
DATES OF ABSENCE
DATES OF ABSENCE
PLEASE CIRCLE:
PLEASE CIRCLE:
Tardy
Illness
Doctor’s Appt.
Tardy
Illness
Doctor’s Appt.
Other (please specify)
Other (please specify)
Reason:
Reason:
Parent/Guardian Signature:
Parent/Guardian Signature:
Person Picking Up Child:
Person Picking Up Child:
Office Comments:
Office Comments:
OFFICE USE ONLY: TIME IN: ____________ OUT: _________
OFFICE USE ONLY: TIME IN: ____________ OUT: _________
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Parent category: Education