Name of Pupil ______________________________________________
Last First Grade Teacher
Address _____________________________________________ School
ABSENCE FROM SCHOOL REPORT BY PARENT
Reason for Absence (circle one): Illness; Quarantine; Medical Appointment;
Family Funeral; (If illness, be specific as to nature) ___________________
Inclusive dates of absence from _____to_____ Total days absent ______
All the above absence was with my full knowledge and consent: Yes No
Date: ____________ Parent’s Signature: ________________________
VERIFICATION OF ABSENCE DUE TO ILLNESS
This illness was verified by means of note, conference, inspection or
telephone on _________,20___, and I hereby certify that the statements
given above are to the best of my knowledge and belief true and correct.
Signed: _____________________________________