Lebanon Middle School

Reason for Absence Note

  Date: _______________________
My child _____________________________ was absent on _____________________ as a result of:
Please check the reason that applies to your child.
_____ Illness (The school reserves the right to require medical confirmation of illness in the case of chronic or lengthy absences (beyond 5 days)).
_____ Death in the Family.
_____ Medical, Professional, or Legal Appointments (that cannot be scheduled after school hours).
_____ Religious Observance (required by the tenets of the faith).
_____ Family Emergency (explain)
_____ Other Educational Experience (A detailed description of the learning experiences had by the student must be attached).
_____ Hospitalization (explain)
_____ Court Appearance.
_____ Other:

 

Parent/Guardian Signature: ______________________________

Excused Absences include illness, death in the family, medical, professional or legal appointments, religious observance, family emergency, other educational experience, hospitalization and court appearance.

Unexcused Absences include any absence where written notificationof the reasons define under excused absences is not received within three days of the absence or absences due to reasons not listed under excused absences.

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  (For school office use only)  
Date Received: _______________ Excused Absence Unexcused Absence
Comments: ____________________________________________________________________